Provider Demographics
NPI:1699777961
Name:CRANE REHAB CENTER LLC
Entity type:Organization
Organization Name:CRANE REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:504-828-7696
Mailing Address - Street 1:101 RIVER RD
Mailing Address - Street 2:STE 112
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4226
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:504-828-8935
Practice Address - Street 1:101 RIVER RD
Practice Address - Street 2:STE 112
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4226
Practice Address - Country:US
Practice Address - Phone:504-828-7696
Practice Address - Fax:504-828-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL#Z10453261Q00000X
LA01635261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C526Medicare ID - Type UnspecifiedMEDICARE NUMBER/CRANE REH