Healthcare Provider Details

I. General information

NPI: 1689832644
Provider Name (Legal Business Name): BROTHERS THAT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55265 CAMBRE ST
WHITE CASTLE LA
70788-2112
US

IV. Provider business mailing address

PO BOX 153
WHITE CASTLE LA
70788-0153
US

V. Phone/Fax

Practice location:
  • Phone: 225-687-0396
  • Fax: 225-687-0396
Mailing address:
  • Phone: 225-687-0396
  • Fax: 225-687-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WADE R. O'BEAR
Title or Position: CEO/OWNER
Credential:
Phone: 225-687-0396