NPI | 1962523589 |
---|---|
Entity Type | Organization |
Authorized Contact | ANGELA T BRANDON Owner 225-925-5003 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: LA 11299) |
Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: LA 11297) |
Enumeration Date | 2007-04-02 |
Last Update Date | 2020-08-22 |