| NPI | 1720027105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA ANN BANKS Owner 225-936-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2011-10-19 |