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General NPI Number Information
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NPI Number | 1467683458
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY OF G.N.O., INC.
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 2200 VETERANS MEMORIAL BLVD STE 103
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City | KENNER
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State | LA
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Zip | 70062-4001
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Country | US
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Telephone | 504-461-4266
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Fax | 504-461-9976
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Provider Business Mailing Address
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Address Line | 2200 VETERANS MEMORIAL BLVD STE 103
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City | KENNER
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State | LA
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Zip | 70062-4001
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Country | US
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Telephone | 504-461-4266
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Fax | 504-461-9976
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JO BUGG
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Credential |
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Telephone | 504-461-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 4502096
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License Number State | LA
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