Provider Demographics
NPI:1699978619
Name:LOUISIANA HEALTH & REHABILITATION COPTIONS
Entity type:Organization
Organization Name:LOUISIANA HEALTH & REHABILITATION COPTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOUNDRA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-938-0661
Mailing Address - Street 1:1033 N LOBDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2233
Mailing Address - Country:US
Mailing Address - Phone:225-231-2490
Mailing Address - Fax:225-231-2857
Practice Address - Street 1:930 WEBB ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3930
Practice Address - Country:US
Practice Address - Phone:337-267-7375
Practice Address - Fax:337-269-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 11824103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1453781Medicaid