| NPI | 1154547578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA GRAHAM Director 318-219-4101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: LA RC 7049) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-10-15 |