| NPI | 1770775108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH AVERY VICTOR Administrator 985-651-7887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: LA 10007) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: LA 9581) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2007-08-09 |