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General NPI Number Information
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NPI Number | 1073971297
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Entity Type | Organization
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Legal Business Name | CORE AGENCY GROUP
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 865 WILLIAMS COLONY RD
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City | DOWNSVILLE
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State | LA
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Zip | 71234-5905
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Country | US
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Telephone | 318-789-6819
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Fax |
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Provider Business Mailing Address
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Address Line | 122 GRIFFIN RD
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City | DOWNSVILLE
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State | LA
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Zip | 71234-5700
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Country | US
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Telephone | 318-789-6819
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE APPLEWHITE
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Credential | MS
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Telephone | 318-789-6819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | LA
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