Organization
HAVENS GATEWAY PERSONAL CARE FACILITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALFREDA CARTER JACKSON BA (DIRECTOR ADMINISTRATOR)
(225) 343-4740
Entity
Organization
Contact information
Practice address
1200 S ACADIAN THRUWAY, 212, BATON ROUGE, LA 70806-6900
(225) 343-4740
(225) 343-4742
Mailing address
1200 S ACADIAN THRUWAY, 212, BATON ROUGE, LA 70806-6900
(225) 343-4740
(225) 343-4742
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
RC 13015
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072583
—
LA
05
—
RC 13015
—
LA
Enumeration date
06/09/2008
Last updated
11/20/2008
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