NPI | 1457576977 |
---|---|
Doing Business As | MADONNA DRIVE COMMUNITY HOME |
Entity Type | Organization |
Authorized Contact | SHERRI A EVANS Mr Dd Regional Administrator 318-641-2003 |
Organization Subpart ? | No |
Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: LA 1006) |
Enumeration Date | 2007-04-17 |
Last Update Date | 2020-08-22 |