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Organization

RESURRECTION CENTER OF LOUISIANA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. OMISHA MICHELLE BANKS (OWNER)
(318) 455-7275
Entity
Organization

Contact information

Practice address
515 E WASHINGTON ST, SUITE B, SHREVEPORT, LA 71104-3658
(318) 455-7275
(318) 658-9134
Mailing address
515 E WASHINGTON ST, SUITE B, SHREVEPORT, LA 71104-3658
(318) 455-7275
(318) 658-9134

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LOUISIANA
LA
Enumeration date
06/25/2013
Last updated
06/25/2013
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