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General NPI Number Information
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NPI Number | 1073850277
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Entity Type | Organization
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Legal Business Name | THE BETTY AND LEONARD PHILLIPS DEAF ACTION CENTER
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 601 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4748
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Country | US
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Telephone | 318-425-7781
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Fax | 318-226-1299
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Provider Business Mailing Address
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Address Line | 601 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4748
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Country | US
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Telephone | 318-425-7781
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Fax | 318-226-1299
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID W HYLAN JR.
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Credential |
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Telephone | 318-425-7781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 0011028
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License Number State | LA
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