Organization
SHEKINAH GLORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA DENISE CARTER COUNSELOR (PASTOR)
(225) 346-5225
Entity
Organization
Contact information
Practice address
3613 GOVERNMENT ST, BATON ROUGE, LA 70806-5721
(225) 346-5225
(225) 346-5226
Mailing address
PO BOX 53766, BATON ROUGE, LA 70892-3766
(225) 346-5225
(225) 346-5226
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
PCA 12390
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1506851
—
LA
Enumeration date
10/02/2007
Last updated
10/02/2007
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