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Organization
MIND REHABILITATION AND RESOURCE CENTER, INC
Active
Organization
MIND REHABILITATION AND RESOURCE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN AKACHUKWU CHINWEZE (ADMINISTRATOR)
(713) 553-5863
Entity
Organization
Contact information
Practice address
6009 FINANCIAL PLZ STE 102, SHREVEPORT, LA 71129-2615
(318) 828-1455
Mailing address
6009 FINANCIAL PLZ STE 102, SHREVEPORT, LA 71129-2615
(318) 828-1455
(318) 828-1626
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
LA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154547578
—
LA
05
—
1194941518
—
LA
05
—
1194941526
—
LA
05
—
1245456664
—
LA
05
—
1427274851
—
LA
05
—
1447474135
—
LA
05
—
1629294053
—
LA
05
—
1841414489
—
LA
Enumeration date
07/07/2011
Last updated
07/08/2023
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