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NPI Code Detail

MEDICARE: MIRACLE OUTLOOK FAMILY SERVICES

MEDICARE: MIRACLE OUTLOOK FAMILY SERVICES
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
1251C00000XDevelopmentally Disabled Services Day Training Agency10403LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932395340
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRACLE OUTLOOK FAMILY SERVICES
Provider Business Mailing Address
First Line : 2404 FERRAND ST
Second Line : SUITE 21
City : MONROE
State : LA
Zip : 71201-4954
Country : US
Telephone Number : 318-324-0048
Fax Number :
Provider Business Practice Location Address
First Line : 2404 FERRAND ST
Second Line : SUITE 21
City : MONROE
State : LA
Zip : 71201-3234
Country : US
Telephone Number : 318-324-0048
Fax Number :
Authorized Official
Title or Position : OWNER
Name : REGINA JACKSON
Credential :
Telephone Number : 318-324-0048
Provider Enumeration Date : 09/19/2007
Last Update Date : 04/28/2017

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Directions to “MIRACLE OUTLOOK FAMILY SERVICES ” Practice Location

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