Organization
HAVEN'S GATEWAY PERSONAL CARE FACILITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALFREDA JACKSON B.S. (DIRECTOR)
(225) 343-4741
Entity
Organization
Contact information
Practice address
1200 S ACADIAN THRUWAY, SUITE 211, BATON ROUGE, LA 70806-6900
(225) 343-4741
(225) 343-4742
Mailing address
1200 S ACADIAN THRUWAY, SUITE 211, BATON ROUGE, LA 70806-6900
(225) 343-4741
(225) 343-4742
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6770
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028657
—
LA
Enumeration date
05/02/2008
Last updated
05/02/2008
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