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General NPI Number Information
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NPI Number | 1891817151
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Entity Type | Organization
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Legal Business Name | LOVE COVERS MENTAL HEALTH REHABILITATION AGENCY
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 6000 FAIRFIELD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-1916
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Country | US
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Telephone | 318-861-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 FAIRFIELD AVE
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City | SHREVEPORT
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State | LA
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Zip | 71106-1916
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Country | US
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Telephone | 318-861-4357
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HENRY LEE AUBREY SR.
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Credential |
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Telephone | 318-861-4357
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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 | 101YM0800X
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License Number State | LA
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