| NPI | 1952757023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FALLON DAI O'BANNON Behavior Counselor 318-208-0043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2016-05-09 |