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General NPI Number Information
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NPI Number | 1659862324
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Entity Type | Organization
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Legal Business Name | LOUISIANA INSTITUTE OF REHABILITATIVE SERVICES
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 6019 DUBLIN RD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-5237
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Country | US
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Telephone | 804-514-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 6019 DUBLIN RD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-5237
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Country | US
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Telephone | 804-514-9696
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH ANDERSON
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Credential | MSW, MBA
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Telephone | 804-514-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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