Healthcare Provider Details

I. General information

NPI: 1750410684
Provider Name (Legal Business Name): NEAL W.ANGRUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10249 HWY.67 SUITE1
CLINTON LA
70722
US

IV. Provider business mailing address

408 THATCHER LN
MONROE LA
71203-6516
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-3997
  • Fax: 318-651-9107
Mailing address:
  • Phone: 318-450-1478
  • Fax: 318-651-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number7086,7087,7088
License Number StateLA

VIII. Authorized Official

Name: MR. NEAL W ANGRUM
Title or Position: DIRECTOR
Credential: DIRECT OWNER
Phone: 318-450-1478