Organization
PROVISION REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEADRIAN FICKLIN (DIRECTOR)
(318) 238-4030
Entity
Organization
Contact information
Practice address
113 BIENVILLE SQ, NATCHITOCHES, LA 71457-5069
(318) 238-4030
Mailing address
113 BIENVILLE SQ, NATCHITOCHES, LA 71457-5069
(318) 238-4030
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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