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General NPI Number Information
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NPI Number | 1912152018
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE HOMES OF LA. INC
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 942 MCLEMORE DR
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City | BATON ROUGE
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State | LA
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Zip | 70816-1802
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Country | US
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Telephone | 225-275-5303
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Fax | 255-274-1028
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Provider Business Mailing Address
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Address Line | 942 MCLEMORE DR
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City | BATON ROUGE
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State | LA
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Zip | 70816-1802
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Country | US
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Telephone | 225-275-5303
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Fax | 255-274-1028
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. VICKY NOE
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Credential |
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Telephone | 225-275-5303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 629
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License Number State | LA
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