| NPI | 1477242196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLORY MACISAAC Controller 318-268-6101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-04-05 |