| NPI | 1508300104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LITONIA LANDRY Administrator 225-921-4336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2023-06-22 |