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General NPI Number Information
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NPI Number | 1265615306
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Entity Type | Organization
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Legal Business Name | MAXIMA GROUP BEHAVIORAL SERVICES, INC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 1001 15TH AVE
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City | FRANKLINTON
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State | LA
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Zip | 70438-2101
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Country | US
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Telephone | 985-795-1704
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Fax | 985-795-1706
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Provider Business Mailing Address
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Address Line | 1001 15TH AVE
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City | FRANKLINTON
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State | LA
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Zip | 70438-2101
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Country | US
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Telephone | 985-795-1704
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Fax | 985-795-1706
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. BYRON L LEE
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Credential |
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Telephone | 985-795-1704
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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 | PCA 10713
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License Number State | LA
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