Healthcare Provider Details

I. General information

NPI: 1972975225
Provider Name (Legal Business Name): HEALING LIFE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 FERRAND ST STE 9&10
MONROE LA
71201-3242
US

IV. Provider business mailing address

PO BOX 1497
BASTROP LA
71221-1497
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1560
  • Fax: 318-323-5682
Mailing address:
  • Phone: 318-450-2300
  • Fax: 318-283-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. HENRY HARRIS JR.
Title or Position: OWNER
Credential:
Phone: 318-450-2300