LTAC Hospital of Washington-St. Tammany LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

584B Issued in LA

Legal business name

LTAC HOSPITAL OF WASHINGTON-ST. TAMMANY LLC

Practice address

1400 Lindberg Dr
Slidell, LA 70458-8056

Phone

(985) 326-0440

Fax

(985) 326-0559

NPI assigned

May 28, 2009

Organization subpart

No

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

Authorized official

Name

Dawn D. Hargrave

Title

Director of Billing

Phone

(337) 269-9828

Specialties & licenses 1

Addresses

Other names 1

• Slidell-AMG Specialty Hospital Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 192046

Legal name

SLIDELL - A M G SPECIALTY HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Jan 15, 2016

Provider type (POS)

Hospital – Long-term

Participating since

Jan 10, 2004

Last certification

Oct 29, 2014

Beds

40

Ownership / control type

Private (for profit)

Facility address

1400 Lindberg Drive
Slidell, LA 70458

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miyoshi Lizette Henry, M.D.

  • Family Medicine Physician
  • Slidell, LA
  • NPI 1184829525
  NPD (past)

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392076800000",
    "number": "1396970810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE",
            "address_2": "SUITE 500",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083144",
            "telephone_number": "337-269-9828",
            "fax_number": "337-234-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 LINDBERG DR",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704588056",
            "telephone_number": "985-326-0440",
            "fax_number": "985-326-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTAC HOSPITAL OF WASHINGTON-ST. TAMMANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-28",
        "last_updated": "2014-02-11",
        "status": "A",
        "authorized_official_last_name": "HARGRAVE",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "337-269-9828"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "LA",
            "license": "584B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Slidell-AMG Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Hospital in Slidell, LA
• Providers in Slidell, LA by specialty
• Long Term Care Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; 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.