Organization
MIRACLE OUTLOOK FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REGINA L JACKSON (OWNER)
(318) 324-0048
Entity
Organization
Contact information
Practice address
2404 FERRAND ST, SUITE 21, MONROE, LA 71201-3234
(318) 324-0048
(318) 324-0199
Mailing address
2404 FERRAND ST, SUITE 21, MONROE, LA 71201-3234
(318) 324-0048
(318) 324-0199
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
10851
LA
251E00000X
Home Health Agency
2203781289
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1461407
—
LA
05
—
1461849
—
LA
05
—
1529559
—
LA
Enumeration date
07/08/2006
Last updated
04/28/2017
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