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General NPI Number Information
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NPI Number | 1811149305
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Entity Type | Organization
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Legal Business Name | PREMIER COMMUNITY SERVICES, LLC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 3414 MOSS ST SUITE C
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City | LAFAYETTE
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State | LA
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Zip | 70507-6107
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Country | US
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Telephone | 337-269-8915
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Fax | 337-269-8992
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Provider Business Mailing Address
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Address Line | 3414 MOSS ST SUITE C
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City | LAFAYETTE
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State | LA
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Zip | 70507-6107
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Country | US
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Telephone | 337-269-8915
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Fax | 337-269-8992
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. VIRGINIA COLLIN
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Credential | LCSW
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Telephone | 225-933-0142
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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 | 15118
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License Number State | LA
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