Healthcare Provider Details

I. General information

NPI: 1447894241
Provider Name (Legal Business Name): ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 HIGHWAY 1
BOYCE LA
71409-9221
US

IV. Provider business mailing address

PO BOX 7768
ALEXANDRIA LA
71306-0768
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-6443
  • Fax: 318-449-8520
Mailing address:
  • Phone: 318-445-6443
  • Fax: 318-449-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTINA M GUILLOT
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-445-6443