| NPI | 1417352428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIBAL HOLT Administrator 318-619-2992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: LA 2203782155) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2014-11-03 |