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Organization

IMMACULATE HEART OF MARY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BENNETT WADE MORAIN (OWNER)
(337) 623-4100
Entity
Organization

Contact information

Practice address
347 SOUTH PRESTON STREET, MARKSVILLE, LA 71351
(318) 253-5400
(318) 253-5454
Mailing address
P.O. BOX 670, MELVILLE, LA 71353-0670
(337) 623-4100
(337) 623-4102

Taxonomy

Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
PCA15128
LA

Other

Enumeration date
07/29/2011
Last updated
07/29/2011
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