Provider Demographics
NPI:1699233130
Name:RIVER PALMS NURSING & REHAB, LLC
Entity type:Organization
Organization Name:RIVER PALMS NURSING & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE TEAM
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-343-9152
Mailing Address - Street 1:343 3RD ST STE 600
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-1309
Mailing Address - Country:US
Mailing Address - Phone:225-343-9152
Mailing Address - Fax:866-310-5858
Practice Address - Street 1:5301 TULLIS DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8805
Practice Address - Country:US
Practice Address - Phone:504-394-5807
Practice Address - Fax:504-394-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0051001Medicaid