| NPI | 1902024656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS TEDESCO Program Coordinator 985-639-1605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: LA 10386) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |