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 |