| NPI | 1366620494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE PRISOCK Accountant 318-878-9058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care (Licence: LA 3913) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |