=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659565463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST MARYS RESD TRAINING SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2007
-----------------------------------------------------
Last Update Date | 09/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6715 HWY 1 NORTH
-----------------------------------------------------
City | BOYCE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-6443
-----------------------------------------------------
Fax | 318-449-8520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO DRAWER 7768
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-6443
-----------------------------------------------------
Fax | 318-449-8520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE SERVICE DIRECTOR
-----------------------------------------------------
Name | MRS. CHRISTI GUILLOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-445-6443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------