Organization
G B COOLEY-LIVE OAK GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY SANDERLIN CPA (DIRECTOR OF FINANCE)
(318) 396-6300
Entity
Organization
Contact information
Practice address
364 GB COOLEY RD, WEST MONROE, LA 71291-8866
(318) 396-6300
(318) 396-7663
Mailing address
364 GB COOLEY RD, WEST MONROE, LA 71291-8866
(318) 396-6300
(318) 396-7663
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1047
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1047
—
LA
Enumeration date
03/17/2009
Last updated
03/17/2009
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