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General NPI Number Information
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NPI Number | 1104090752
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Entity Type | Organization
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Legal Business Name | G B COOLEY SERVICES/DAY HABILITATION
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 364 GB COOLEY RD
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City | WEST MONROE
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State | LA
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Zip | 71291-8866
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Country | US
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Telephone | 318-396-6300
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Fax | 318-396-7663
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Provider Business Mailing Address
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Address Line | 364 GB COOLEY RD
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City | WEST MONROE
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State | LA
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Zip | 71291-8866
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Country | US
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Telephone | 318-396-6300
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Fax | 318-396-7663
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MR. JIMMY SANDERLIN
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Credential | CPA
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Telephone | 318-396-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ADC 9827
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License Number State | LA
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