| NPI | 1154592996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT E BLACKMAN Administrator 318-640-2953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: LA 5373) |
| Additional Taxonomies | 251C00000X (Licence: LA 5373) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2011-09-12 |