Healthcare Provider Details

I. General information

NPI: 1932393741
Provider Name (Legal Business Name): ST MARYS RESD TRAINING SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6690 ANTOINETTE STREET
BOYCE LA
71409-9312
US

IV. Provider business mailing address

PO DRAWER 7768
ALEXANDRIA LA
71306
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-0904
  • Fax:
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 Number994
License Number StateLA

VIII. Authorized Official

Name: MRS. CHRISTI GUILLOT
Title or Position: ADMINISTRATIVE SERVICE DIRECTOR
Credential:
Phone: 318-445-6443