| NPI | 1730803859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETATIA R VANCE Administrator 318-572-6606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-12-01 |