Organization
SOUTHERN REHAB & MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH LEACH (PRESIDENT)
(504) 835-6845
Entity
Organization
Contact information
Practice address
3511 RIVER RD, SUITE B, JEFFERSON, LA 70121-4160
(504) 835-6845
(504) 835-7811
Mailing address
PO BOX 7220, METAIRIE, LA 70010-7220
(504) 835-6845
(504) 835-7811
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
3236908001
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1431478
—
LA
01
—
F7457
DME
LA
Enumeration date
05/27/2006
Last updated
10/26/2011
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