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General NPI Number Information
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NPI Number | 1346937745
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Entity Type | Organization
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Legal Business Name | FIX YOUR CROWN FOUNDATION
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 8656 HIGHWAY 165 N APT 16
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City | MONROE
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State | LA
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Zip | 71203-8709
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Country | US
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Telephone | 682-215-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 8656 HIGHWAY 165 N APT 16
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City | MONROE
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State | LA
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Zip | 71203-8709
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Country | US
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Telephone | 682-215-2860
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOLANDA THOMAS
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Credential |
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Telephone | 682-215-2860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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