Healthcare Provider Details

I. General information

NPI: 1578826137
Provider Name (Legal Business Name): CANE RIVER CHILDREN'S SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 RUE DEGABRIEL
NATCHITOCHES LA
71457
US

IV. Provider business mailing address

PO BOX 2453
NATCHITOCHES LA
71457-2453
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9349
  • Fax: 318-352-9345
Mailing address:
  • Phone: 318-352-9349
  • Fax: 318-352-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number6318
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number13372
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JENNIFER KARLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MED
Phone: 318-352-9349