Healthcare Provider Details

I. General information

NPI: 1013150200
Provider Name (Legal Business Name): TAFT COMMUNITY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 WHITEFIELD BLVD
ALEXANDRIA LA
71303-2925
US

IV. Provider business mailing address

PO BOX 7917
ALEXANDRIA LA
71306-0917
US

V. Phone/Fax

Practice location:
  • Phone: 318-449-8787
  • Fax: 318-449-8782
Mailing address:
  • Phone: 318-445-1551
  • Fax: 318-445-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number1053
License Number StateLA

VIII. Authorized Official

Name: CHRISTINA BONNETTE BOLTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-445-1551