Organization
REHAB SERVICES OF CENLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE JACOB (CFO)
(318) 747-8895
Entity
Organization
Contact information
Practice address
1450 PETERMAN DR STE A, ALEXANDRIA, LA 71301-3432
(318) 473-4328
Mailing address
1000 CHINABERRY DR STE 900, BOSSIER CITY, LA 71111-2455
(318) 746-0420
(318) 626-5429
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1143731
—
LA
Enumeration date
04/23/2007
Last updated
07/24/2023
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