Organization
WOODLAKE ADDICTION RECOVERY OF MISSISSIPPI, LLC
Active
Parent organization
WOODLAKE MANAGEMENT, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WOODLAKE MANAGEMENT, LLC
Authorized official
KENDALL MCCULLAR (CREDENTIALING SPECIALIST)
(225) 900-8940
Entity
Organization
Contact information
Practice address
152 GATEWAY DR, BILOXI, MS 39531-4409
(225) 924-1910
Mailing address
PO BOX 41853, BATON ROUGE, LA 70835-1853
(225) 900-8940
(855) 532-9362
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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