Organization
FPHSA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NADINE FACIANE (PROGRAM DIRECTOR)
(985) 624-4100
Entity
Organization
Contact information
Practice address
23515 HIGHWAY 190, MANDEVILLE, LA 70448-7334
(985) 624-4100
(985) 624-4123
Mailing address
PO BOX 37, MANDEVILLE, LA 70470-0037
(985) 624-4100
(985) 624-4123
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
960733
LA
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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