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Organization

CLEVELAND COMMUNITY HOME

Active
Parent organization
WESTSIDE HABILITATION CENTER
Organization subpart
Yes

Provider details

NPI number
Legal business name
WESTSIDE HABILITATION CENTER
Authorized official
CHRISTINA BONNETTE BOLTON (ADMINISTRATOR)
(318) 445-1551
Entity
Organization

Contact information

Practice address
5621 HERA ST, ALEXANDRIA, LA 71303-2212
(318) 487-1249
(318) 487-1248
Mailing address
PO BOX 7917, ALEXANDRIA, LA 71306-0917
(318) 445-1551
(318) 445-1242

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
1052
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
19G652
LA
Enumeration date
04/17/2009
Last updated
11/05/2009
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