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General NPI Number Information
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NPI Number | 1588960058
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Entity Type | Organization
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Legal Business Name | OVERTON ENTERPRISE
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 57685 ELI CRAIG RD
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City | PLAQUEMINE
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State | LA
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Zip | 70764-4544
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Country | US
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Telephone | 225-371-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 57685 ELI CRAIG RD
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City | PLAQUEMINE
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State | LA
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Zip | 70764-4544
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Country | US
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Telephone | 225-371-2059
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATRICIA OVERTON DIXON
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Credential |
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Telephone | 225-371-2059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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