Organization
IMPAC REHABILITATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY RUTH MCVAY SPEECH PATHOLOGIST (PRESIDENT)
(507) 779-0400
Entity
Organization
Contact information
Practice address
4937 HEARST STREET, SUITE 2-F, METAIRIE, LA 70001
(504) 779-0400
Mailing address
4937 HEARST STREET, SUITE 2-F, METAIRIE, LA 70001
(504) 779-0400
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1438413
—
LA
Enumeration date
10/13/2005
Last updated
08/22/2020
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