Healthcare Provider Details

I. General information

NPI: 1851632699
Provider Name (Legal Business Name): ST. NICHOLAS CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 BROAD ST STE B
LAKE CHARLES LA
70601-4224
US

IV. Provider business mailing address

314 BROAD ST STE B
LAKE CHARLES LA
70601-4224
US

V. Phone/Fax

Practice location:
  • Phone: 337-491-0800
  • Fax:
Mailing address:
  • Phone: 337-491-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number1-13-13330
License Number StateLA

VIII. Authorized Official

Name: MRS. CHRISTY PAPINIA-JONES
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential:
Phone: 337-491-0800