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General NPI Number Information
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NPI Number | 1154876837
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Entity Type | Organization
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Legal Business Name | G B COOLEY HOSPITAL FOR RETARDED
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 211 N 3RD ST
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City | MONROE
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State | LA
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Zip | 71201-6731
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Country | US
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Telephone | 318-397-6679
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Fax | 318-397-9271
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Provider Business Mailing Address
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Address Line | 211 N 3RD ST
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City | MONROE
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State | LA
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Zip | 71201-6731
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Country | US
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Telephone | 318-397-6679
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Fax | 318-397-9271
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Authorized Official
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Title or Position | CFO
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Name | MR. JIMMY SANDERLIN
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Credential | CPA
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Telephone | 318-397-6679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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