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General NPI Number Information
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NPI Number | 1366775116
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Entity Type | Organization
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Legal Business Name | LIBERTY RESTORATION COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 12415 WARDLINE RD
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City | HAMMOND
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State | LA
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Zip | 70401-6210
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Country | US
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Telephone | 985-340-7033
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Fax | 985-340-7035
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Provider Business Mailing Address
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Address Line | 12415 WARDLINE RD
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City | HAMMOND
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State | LA
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Zip | 70401-6210
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Country | US
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Telephone | 985-340-7033
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Fax | 985-340-7035
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ANNETTE JOHNSON
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Credential |
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Telephone | 985-340-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | LA
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