| NPI | 1235369216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA LEE MADISE Behavior Shaping Specialist 985-385-1054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2018-06-21 |