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General NPI Number Information
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NPI Number | 1245443084
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Entity Type | Organization
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Legal Business Name | AMIAN HEALTH SERVICES OF LAKE CHARLES
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 710 W PRIEN LAKE RD SUITE 206
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8349
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Country | US
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Telephone | 337-477-7083
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Fax |
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Provider Business Mailing Address
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Address Line | 710 W PRIEN LAKE RD SUITE 206
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8349
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Country | US
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Telephone | 337-477-7083
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Fax | 337-478-4414
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILLIP PAPILLION
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Credential |
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Telephone | 337-477-7083
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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 | 6986
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License Number State | LA
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