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General NPI Number Information
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NPI Number | 1659627230
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Entity Type | Organization
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Legal Business Name | ST JOHN ASSOCIATION FOR RETARDED CITIZENS
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 101 BAMBOO RD
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City | LA PLACE
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State | LA
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Zip | 70068-6457
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Country | US
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Telephone | 985-652-5706
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Fax | 985-652-2536
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Provider Business Mailing Address
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Address Line | 101 BAMBOO RD
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City | LA PLACE
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State | LA
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Zip | 70068-6457
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Country | US
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Telephone | 985-652-5706
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Fax | 985-652-2536
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Authorized Official
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Title or Position | IFSS DIRECTOR
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Name | JEAN HUTCHINSON
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Credential |
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Telephone | 985-652-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4824
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License Number State | LA
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