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General NPI Number Information
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NPI Number | 1407042567
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Entity Type | Organization
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Legal Business Name | COLWELL INTEREST, INC.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 3004 HIGHWAY 457
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City | ALEXANDRIA
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State | LA
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Zip | 71302-9255
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Country | US
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Telephone | 318-442-5266
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Fax | 318-442-5266
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Provider Business Mailing Address
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Address Line | 1111 MAIN ST
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City | PINEVILLE
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State | LA
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Zip | 71360-6423
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Country | US
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Telephone | 318-442-2284
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Fax | 318-448-1427
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. JAMES B. COLWELL
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Credential |
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Telephone | 318-442-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 485
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License Number State | LA
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