Kailo LTAC Hospital, LLC

Primary specialty

Special HospitalTaxonomy code 284300000X

License

532 Issued in LA

Legal business name

KAILO LTAC HOSPITAL, LLC

Practice address

713 N Avenue L
Crowley, LA 70526-3832

Phone

(337) 783-2859

Fax

(337) 783-2891

NPI assigned

Apr 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. E. Paul Broussard

Title

Ceo/Cfo

Phone

(337) 788-3600

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Crowley Rehab Hospital, LLC Former legal business name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 192050

Legal name

KAILO L T A C HOSPITAL, L L C

Certification status

Terminated Voluntary: merger or closure, Nov 21, 2014

Provider type (POS)

Hospital – Long-term

Participating since

Jun 11, 2004

Last certification

Apr 18, 2013

Beds

15

Ownership / control type

Private (for profit)

Facility address

713 North Avenue L
Crowley, LA 70526

Hospital certification: CCN 193088

Legal name

CROWLEY REHAB HOSP, LLC

Certification status

Terminated Voluntary: other reason for withdrawal, Jan 14, 2005

Provider type (POS)

Hospital – Rehabilitation

Participating since

Jun 11, 2004

Last certification

Jun 11, 2004

Beds

15

Ownership / control type

Private (for profit)

Facility address

713 North Avenue L
Crowley, LA 70526

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Family Clinic of Crowley, Inc

  • Family Medicine Physician
  • Crowley, LA
  • NPI 1689782286

  Member Of

  NPD member

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1457313827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 N AVENUE L",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705263832",
            "telephone_number": "337-783-2859",
            "fax_number": "337-783-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 N AVENUE L",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705263832",
            "telephone_number": "337-783-2859",
            "fax_number": "337-783-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAILO LTAC HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "E. PAUL",
        "authorized_official_title_or_position": "CEO/CFO",
        "authorized_official_telephone_number": "337-788-3600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "LA",
            "license": "532",
            "primary": false
        },
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "LA",
            "license": "532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1703109",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crowley Rehab Hospital, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Marlonara D Johnson
• Rylie Johnson, PLPC, PLMFT
• Michael Ray Johnston, LCSW
• Just Health
• Just Health
• Mulraj Narsidas Katira, MD
• Kevin W Young, a Professional Medical Corporation
• Allison Cara Kidder, LCSW
• Karrie V Kilgore, M.D.
• Anne H King, LMSW

• Special Hospital in Crowley, LA
• Providers in Crowley, LA by specialty
• Special Hospital in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; 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.