Premier Rehabilitation Hospital, LLC

Primary specialty

Rehabilitation HospitalTaxonomy code 283X00000X

Legal business name

PREMIER REHABILITATION HOSPITAL, LLC

Practice address

4310 S Grand St
Monroe, LA 71202-6322

Phone

(318) 812-1000

Fax

(318) 812-1012

NPI assigned

Jul 22, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott Markstrom

Title

Cfo

Phone

(337) 993-5711

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306846050. Details of each certification follow.

• CCN 193082 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 193082

Legal name

PREMIER REHABILITATION HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Nov 21, 2008

Provider type (POS)

Hospital – Rehabilitation

Participating since

Nov 12, 2002

Last certification

Nov 12, 2002

Beds

12

Ownership / control type

Private (for profit)

Facility address

4310 South Grand St
Monroe, LA 71202

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306846050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026322",
            "telephone_number": "318-812-1000",
            "fax_number": "318-812-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026322",
            "telephone_number": "318-812-1000",
            "fax_number": "318-812-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER REHABILITATION HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARKSTROM",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-993-5711",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1702102",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Elaina Presley
• Sara Prewitt, LPC

• Rehabilitation Hospital in Monroe, LA
• Providers in Monroe, LA by specialty
• Rehabilitation Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.