Healthcare Provider Details

I. General information

NPI: 1457783078
Provider Name (Legal Business Name): WALK WITH ME COMMUNITY IMPROVEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 11/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19331 N 12TH ST
COVINGTON LA
70433-5228
US

IV. Provider business mailing address

19331 N 12TH ST
COVINGTON LA
70433-5228
US

V. Phone/Fax

Practice location:
  • Phone: 985-400-5901
  • Fax: 985-400-5164
Mailing address:
  • Phone: 985-400-5901
  • Fax: 985-400-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATOYIA LASHAY PORTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 985-400-5901