Provider Demographics
NPI:1972968949
Name:EXCEPTIONAL REHABILITATION LLC
Entity type:Organization
Organization Name:EXCEPTIONAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EACKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-439-1720
Mailing Address - Street 1:8155 JEFFERSON HWY
Mailing Address - Street 2:903
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1604
Mailing Address - Country:US
Mailing Address - Phone:225-439-1720
Mailing Address - Fax:
Practice Address - Street 1:8155 JEFFERSON HWY
Practice Address - Street 2:903
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1604
Practice Address - Country:US
Practice Address - Phone:225-439-1720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children