Healthcare Provider Details

I. General information

NPI: 1225278427
Provider Name (Legal Business Name): HARDING COMMUNITY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WESTWIND DR
ALEXANDRIA LA
71303-3800
US

IV. Provider business mailing address

PO BOX 7917
ALEXANDRIA LA
71306-0917
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-1328
  • Fax: 318-487-1329
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 Number1051
License Number StateLA

VIII. Authorized Official

Name: MRS. CHRISTINA BONNETTE BOLTON
Title or Position: ADMINISTRATOR
Credential: M.S.
Phone: 318-445-1551