Provider Demographics
NPI:1053402453
Name:HEALTHWORK REHAB, LLC
Entity type:Organization
Organization Name:HEALTHWORK REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:POCHE'
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:337-363-2600
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0695
Mailing Address - Country:US
Mailing Address - Phone:337-363-2600
Mailing Address - Fax:337-363-2599
Practice Address - Street 1:1477 W LASALLE ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-2974
Practice Address - Country:US
Practice Address - Phone:337-363-2600
Practice Address - Fax:337-363-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01879225100000X
LA01613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437884682AOtherBLUECROSS OF LA
LA433337544AOtherBLUECROSS OF LA
LA437884682AOtherBLUECROSS OF LA
LA4B981CA03Medicare ID - Type UnspecifiedMEDICARE PROVIDER#/GRP
LA4740870001Medicare NSC