| NPI | 1588006886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE ROACH Owner 225-756-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA 2203781706) |
| Additional Taxonomies | 251B00000X Case Management |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2022-02-14 |