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General NPI Number Information
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NPI Number | 1275050049
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Entity Type | Organization
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Legal Business Name | RESILIENT HOUSE, LLC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7020 KLUG PINES RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-3300
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Country | US
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Telephone | 318-606-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 7020 KLUG PINES RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-3300
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Country | US
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Telephone | 318-606-5416
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. TOM E. TURNBOW JR.
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Credential | CPA
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Telephone | 318-469-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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