| NPI | 1275987307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVIA JACKOSN Administrator 504-208-9636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 1548408958) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: LA 1364878) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |