| NPI | 1902263643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINDA BERGERON Counselor 985-870-4599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: LA OC24442) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-26 |