Organization
KAILO LTAC HOSPITAL, LLC
Active
Other names
Crowley Rehab Hospital, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. E. PAUL BROUSSARD (CEO/CFO)
(337) 788-3600
Entity
Organization
Contact information
Practice address
713 N AVENUE L, CROWLEY, LA 70526-3832
(337) 783-2859
(337) 783-2891
Mailing address
713 N AVENUE L, CROWLEY, LA 70526-3832
(337) 783-2859
(337) 783-2891
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
532
LA
284300000X
Special Hospital
Primary
532
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1703109
—
LA
Enumeration date
04/03/2006
Last updated
01/22/2013
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