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General NPI Number Information
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NPI Number | 1629145628
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Entity Type | Organization
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Legal Business Name | COGNITIVE DEVELOPMENT CENTER PERSONAL CARE SERVICES
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1811 ROSELAWN AVE
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City | MONROE
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State | LA
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Zip | 71201-5433
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Country | US
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Telephone | 318-651-8079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7563
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City | MONROE
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State | LA
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Zip | 71211-7563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ADRIAN FISHER
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Credential |
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Telephone | 318-651-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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