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General NPI Number Information
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NPI Number | 1851688105
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Entity Type | Organization
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Legal Business Name | MIND REHABILITATION AND RESOURCE CENTER, INC
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 07/08/2023
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Provider Practice Location Address
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Address Line | 6009 FINANCIAL PLZ STE 102
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City | SHREVEPORT
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State | LA
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Zip | 71129-2615
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Country | US
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Telephone | 318-828-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 6009 FINANCIAL PLZ STE 102
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City | SHREVEPORT
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State | LA
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Zip | 71129-2615
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Country | US
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Telephone | 318-828-1455
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Fax | 318-828-1626
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEN AKACHUKWU CHINWEZE
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Credential |
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Telephone | 713-553-5863
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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 | LA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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