Provider Demographics
NPI:1962424556
Name:THE NEURO MEDICAL CENTER REHABILITATION HOSPITAL
Entity type:Organization
Organization Name:THE NEURO MEDICAL CENTER REHABILITATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-906-3822
Mailing Address - Street 1:10101 PARK ROWE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1685
Mailing Address - Country:US
Mailing Address - Phone:225-906-2999
Mailing Address - Fax:225-906-3837
Practice Address - Street 1:10101 PARK ROWE AVE
Practice Address - Street 2:STE 600
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810
Practice Address - Country:US
Practice Address - Phone:225-906-2999
Practice Address - Fax:225-906-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA560283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61330OtherBLUE CROSS BLUE SHIELD
LA1704059Medicaid
193090Medicare ID - Type Unspecified