Organization
A-1 CUSTOMIZED COMPANION SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS MELANCON (CEO)
(504) 913-5452
Entity
Organization
Contact information
Practice address
2100 BELLE CHASE HWY, GRETNA, LA 70053-6651
(504) 361-5330
(504) 367-6601
Mailing address
2100 BELLE CHASE HWY, GRETNA, LA 70053-6651
(504) 361-5330
(504) 367-6601
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024
—
LA
Enumeration date
10/04/2010
Last updated
10/04/2010
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