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General NPI Number Information
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NPI Number | 1225744576
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Entity Type | Organization
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Legal Business Name | NORMAL LIFE FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 900 W MORRIS AVE
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City | HAMMOND
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State | LA
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Zip | 70403-4054
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Country | US
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Telephone | 985-340-8165
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY STE 400
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGR PROVIDER ENROLLMENT
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Name | ANGIE MATTINGLY
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Credential |
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Telephone | 502-630-7425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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