Provider Demographics
NPI:1992124697
Name:REHABILITATION HOSPITAL OF LEESVILLE LLC
Entity type:Organization
Organization Name:REHABILITATION HOSPITAL OF LEESVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-317-3802
Mailing Address - Street 1:5600 WYOMING BLVD NE STE 225
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3136
Mailing Address - Country:US
Mailing Address - Phone:505-317-3802
Mailing Address - Fax:
Practice Address - Street 1:900 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4723
Practice Address - Country:US
Practice Address - Phone:337-392-8118
Practice Address - Fax:337-392-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1702951Medicaid