Organization
THE VIRGINIA HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEVELAND MOUTON III (PRESIDENT)
(318) 820-6941
Entity
Organization
Contact information
Practice address
344 BOULEVARD ST, SHREVEPORT, LA 71104-2422
(318) 820-6941
Mailing address
344 BOULEVARD ST, SHREVEPORT, LA 71104-2422
(318) 820-6941
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
08/16/2022
Last updated
01/25/2024
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