| NPI | 1528564358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY ELEAM Owner 318-600-3962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| 251S00000X (Licence: LA BH0012306) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2021-08-23 |