NPI | 1902080146 |
---|---|
Entity Type | Organization |
Authorized Contact | SHANNON WILLIAMS SIMMONS Program Administrator 225-803-8217 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA PCA 14063) |
Enumeration Date | 2007-12-24 |
Last Update Date | 2007-12-24 |