MEDICARE: RESILIENT HOUSE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1275050049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT HOUSE, LLC

Provider Business Mailing Address
First Line	:	7020 KLUG PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3300
Country	:	US
Telephone Number	:	318-606-5416
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 KLUG PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3300
Country	:	US
Telephone Number	:	318-606-5416
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. TOM E. TURNBOW JR.
Credential	:	CPA
Telephone Number	:	318-469-1963

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	07/21/2022

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Directions to “RESILIENT HOUSE, LLC ” Practice Location

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