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Organization
NORTHWEST SUPPORTS AND SERVICES CENTER
Active
Organization
NORTHWEST SUPPORTS AND SERVICES CENTER
Active
Other names
Northwest Louisiana Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID COLVIN (ADMINISTRATOR)
(318) 741-5200
Entity
Organization
Contact information
Practice address
5401 SHED RD, BOSSIER CITY, LA 71111-5420
(318) 741-5230
(318) 741-5303
Mailing address
5401 SHED RD, BOSSIER CITY, LA 71111-5420
(318) 741-5230
(318) 741-5303
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
750000461
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1156752
—
LA
05
—
1156761
—
LA
05
—
1408182
—
LA
05
—
1567230
—
LA
05
—
1712035
—
LA
Enumeration date
02/09/2007
Last updated
02/27/2009
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