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General NPI Number Information
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NPI Number | 1437320751
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Entity Type | Organization
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Legal Business Name | SOUTHERN INGENUITY, INC.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 598 HARMON LOOP
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City | HOMER
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State | LA
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Zip | 71040-5830
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Country | US
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Telephone | 318-927-5046
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Fax | 318-927-5055
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | HOMER
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State | LA
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Zip | 71040-0038
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Country | US
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Telephone | 318-927-5046
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Fax | 318-927-5055
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DARYN R. CLARK
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Credential |
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Telephone | 318-927-5068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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