Organization
LOUISIANA REHAB PRODUCTS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKY WALTER DECASTRO SR. (OWNER/PRESIDENT)
(504) 468-6100
Entity
Organization
Contact information
Practice address
2424 WILLIAMS BLVD, SUITE C, KENNER, LA 70062-5763
(504) 468-6100
(504) 468-6109
Mailing address
2424 WILLIAMS BLVD, SUITE C, KENNER, LA 70062-5763
(504) 468-6100
(504) 468-6109
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1998214
—
LA
01
—
77610
BLUE CROSS BLUE SHIELD OF LOUISIANA
LA
Enumeration date
10/28/2006
Last updated
03/24/2011
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