Healthcare Provider Details

I. General information

NPI: 1902322233
Provider Name (Legal Business Name): NEW CONCEPT DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15365 HWY 80
MINDEN LA
71055
US

IV. Provider business mailing address

15365 HIGHWAY 80
MINDEN LA
71055-6367
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-4549
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783449
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2203783449
License Number StateLA

VIII. Authorized Official

Name: KIMBERLY WESTON
Title or Position: PROGRAM MGR
Credential:
Phone: 318-517-7541