| NPI | 1023113651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE LEE JONES Executive Director 318-222-0991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: LA 356) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |