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General NPI Number Information
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NPI Number | 1740650647
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Entity Type | Organization
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Legal Business Name | MISSION IMPROVE CARE ADDICTION HOUSING INC.
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 10086 PINE ORCHARD RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-8784
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Country | US
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Telephone | 318-938-5679
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Fax | 318-938-5679
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Provider Business Mailing Address
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Address Line | 10086 PINE ORCHARD RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-8784
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Country | US
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Telephone | 318-938-5679
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Fax | 318-938-5679
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | FLORINE KESSEE SAMUELS
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Credential |
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Telephone | 318-938-5679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1257
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License Number State | LA
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