Organization
ALLEGIANCE HEALTH CENTER OF RUSTON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROCK BORDELON (CEO PRESIDENT)
(318) 226-8202
Entity
Organization
Contact information
Practice address
1401 EZELLE ST, RUSTON, LA 71270-7218
(318) 255-8085
(318) 251-5146
Mailing address
504 TEXAS ST STE 200, SHREVEPORT, LA 71101-3526
(318) 226-8202
(318) 226-8205
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710831
—
LA
Enumeration date
10/03/2006
Last updated
04/16/2008
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