| NPI | 1205328226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY SELDERS Administrator 225-819-7309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |