| NPI | 1073826681 |
|---|---|
| Doing Business As | PROVISION REHAB |
| Entity Type | Organization |
| Authorized Contact | DEADRIAN ANDRELL ALEXANDER-FICKLIN CEO 318-238-4030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2012-02-08 |