| NPI | 1891167623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNIE KAYE BEAUSHAW Owner 985-502-0264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 1942) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |