Healthcare Provider Details

I. General information

NPI: 1730358706
Provider Name (Legal Business Name): FAMILIES IN CONNECTION MINS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MURRAY ST SUITE 105
ALEXANDRIA LA
71301-6890
US

IV. Provider business mailing address

1605 MURRAY ST SUITE 105
ALEXANDRIA LA
71301-6890
US

V. Phone/Fax

Practice location:
  • Phone: 318-767-0842
  • Fax: 318-767-2229
Mailing address:
  • Phone: 318-767-0842
  • Fax: 318-767-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License NumberPCA 10948
License Number StateLA

VIII. Authorized Official

Name: MS. EUNICE ALFRED
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-767-0842