Organization
MIRACLE OUTLOOK FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RGINA JACKSON (OWNER)
(318) 324-0048
Entity
Organization
Contact information
Practice address
2404 FERRAND ST, SUITE 21, MONROE, LA 71201-4954
(318) 324-0048
Mailing address
2404 FERRAND ST, SUITE 21, MONROE, LA 71201-4954
(318) 324-0048
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
10851
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1529559
—
LA
Enumeration date
12/21/2007
Last updated
04/28/2017
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