Healthcare Provider Details

I. General information

NPI: 1578129391
Provider Name (Legal Business Name): POSITIVE FAMILY SUPPORT SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 AVENUE F
BOGALUSA LA
70427-3656
US

IV. Provider business mailing address

748 AVENUE F
BOGALUSA LA
70427-3656
US

V. Phone/Fax

Practice location:
  • Phone: 985-241-5100
  • Fax: 985-241-5337
Mailing address:
  • Phone: 985-241-5100
  • Fax: 985-241-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARLES E MIZELL
Title or Position: OWNER
Credential:
Phone: 985-516-5604