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Organization
PHILADELPHIA CENTER
Active
Organization
PHILADELPHIA CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ELGIN BEATTY MS (EXECUTIVE DIRECTOR)
(318) 222-6633
Entity
Organization
Contact information
Practice address
2020 CENTENARY BLVD, SHREVEPORT, LA 71104-2437
(318) 222-6633
(318) 222-6678
Mailing address
2020 CENTENARY BLVD, SHREVEPORT, LA 71104-2437
(318) 222-6633
(318) 222-6678
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CM2271
LA
Other
Enumeration date
04/24/2007
Last updated
08/22/2020
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