Healthcare Provider Details

I. General information

NPI: 1316162688
Provider Name (Legal Business Name): RUSTON DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2887 MOSELEY ST
ARCADIA LA
71001-3815
US

IV. Provider business mailing address

PO BOX 907
RUSTON LA
71273-0907
US

V. Phone/Fax

Practice location:
  • Phone: 318-247-4204
  • Fax: 318-247-4254
Mailing address:
  • Phone: 318-247-4204
  • Fax: 318-247-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number933
License Number StateLA

VIII. Authorized Official

Name: MRS. JANET ROBINSON
Title or Position: DIRECTOR OF ADMINIS
Credential:
Phone: 318-247-4213