Organization
LASTING IMPRESSION CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRU'IESHIA RANEE ANDERSON-MANARD (DIRECTOR)
(504) 227-8343
Entity
Organization
Contact information
Practice address
405 GRETNA BLVD, SUITE 103C, GRETNA, LA 70053-4900
(507) 227-8343
(504) 227-8540
Mailing address
405 GRETNA BLVD, SUITE 103C, GRETNA, LA 70053-4900
(504) 227-8343
(504) 227-8540
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
PCA 14002
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629383
—
LA
Enumeration date
10/09/2007
Last updated
10/09/2007
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