Healthcare Provider Details

I. General information

NPI: 1417733882
Provider Name (Legal Business Name): SOAR TRANSITIONAL HOMES AND RECOVERY CENTERS OF NELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTURY VILLAGE BLVD STE 247
MONROE LA
71203-2006
US

IV. Provider business mailing address

201 CENTURY VILLAGE BLVD STE 247
MONROE LA
71203-2006
US

V. Phone/Fax

Practice location:
  • Phone: 318-395-6619
  • Fax: 318-575-4054
Mailing address:
  • Phone: 318-395-6619
  • Fax: 318-575-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NASIR AL-HAJJ MUHAMMAD
Title or Position: OWNER
Credential:
Phone: 318-395-6619