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General NPI Number Information
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NPI Number | 1427952266
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Entity Type | Organization
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Legal Business Name | BLESSED KIDZ THERAPEUTIC GROUP HOME LLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 2023 SAINT CHARLES ST
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City | JEANERETTE
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State | LA
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Zip | 70544-4225
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Country | US
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Telephone | 337-564-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 SAINT CHARLES ST
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City | JEANERETTE
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State | LA
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Zip | 70544-4225
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Country | US
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Telephone | 337-564-3504
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LADERICAL DELDRA WAGNER
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Credential | JD
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Telephone | 337-380-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | NULL
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