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General NPI Number Information
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NPI Number | 1750410684
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Entity Type | Organization
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Legal Business Name | NEAL W.ANGRUM
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 10249 HWY.67 SUITE1
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City | CLINTON
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State | LA
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Zip | 70722
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Country | US
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Telephone | 225-683-3997
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Fax | 318-651-9107
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Provider Business Mailing Address
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Address Line | 408 THATCHER LN
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City | MONROE
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State | LA
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Zip | 71203-6516
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Country | US
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Telephone | 318-450-1478
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Fax | 318-651-9107
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. NEAL W ANGRUM
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Credential | DIRECT OWNER
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Telephone | 318-450-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 7086,7087,7088
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License Number State | LA
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