Organization
SOUTHERN REHAB & MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH JAMES LEACH (PRESIDENT)
(504) 456-6844
Entity
Organization
Contact information
Practice address
2207 CALIFORNIA DR, STE. 9A, BOSSIER CITY, LA 71111-3571
(318) 747-6118
Mailing address
2207 CALIFORNIA DR, STE. 9A, BOSSIER CITY, LA 71111-3571
(318) 747-6118
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1431478
—
LA
01
—
F7457
BLUE CROSS
LA
Enumeration date
10/16/2006
Last updated
06/27/2013
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