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General NPI Number Information
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NPI Number | 1629939343
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Entity Type | Organization
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Legal Business Name | HOLY ANGELS RESIDENTIAL FACILITY
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Dates
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Enumeration Date | 11/21/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 10450 ELLERBE RD
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City | SHREVEPORT
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State | LA
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Zip | 71106-7730
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Country | US
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Telephone | 318-629-1737
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Fax | 318-797-0801
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Provider Business Mailing Address
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Address Line | 10450 ELLERBE RD
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City | SHREVEPORT
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State | LA
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Zip | 71106-7730
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Country | US
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Telephone | 318-629-1737
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Fax | 318-797-0801
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JANET DIETRICH
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Credential | CPA
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Telephone | 318-629-1737
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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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