Organization
1 PRIORITY INDEPENDENT LIVING SKILLS BUILDING
Active
Organization
1 PRIORITY INDEPENDENT LIVING SKILLS BUILDING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REVIA JACKOSN MSW (ADMINISTRATOR)
(504) 208-9636
Entity
Organization
Contact information
Practice address
321 W JUDGE PEREZ DR, SUITE B, CHALMETTE, LA 70043-4903
(504) 208-9636
Mailing address
321 W JUDGE PEREZ DR, SUITE B, CHALMETTE, LA 70043-4903
(504) 208-9636
(504) 272-2446
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1364878
LA
251S00000X
Community/Behavioral Health Agency
Primary
1548408958
LA
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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