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General NPI Number Information
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NPI Number | 1356586044
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Entity Type | Organization
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Legal Business Name | HOLISTIC EDUCATIONAL REHAB CENTER
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 2100 BELLE CHASE HWY
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City | GRETNA
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State | LA
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Zip | 70053-6651
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Country | US
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Telephone | 504-367-6630
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Fax | 504-367-6601
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Provider Business Mailing Address
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Address Line | 2100 BELLE CHASE HWY
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City | GRETNA
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State | LA
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Zip | 70053-6651
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Country | US
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Telephone | 504-367-6630
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Fax | 504-367-6601
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LA SHUN SENEL DOYLE
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Credential | LAC
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Telephone | 504-367-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 12455
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License Number State | LA
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