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General NPI Number Information
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NPI Number | 1639637671
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Entity Type | Organization
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Legal Business Name | ARC OF DESOTO
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 1528 OLD JEFFERSON HWY
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City | MANSFIELD
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State | LA
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Zip | 71052-3427
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Country | US
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Telephone | 318-872-3255
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Fax | 318-872-3233
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | MANSFIELD
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State | LA
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Zip | 71052-0230
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Country | US
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Telephone | 318-872-3255
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Fax | 318-872-3233
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICTORIA JACKSON
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Credential |
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Telephone | 318-872-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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