Organization
LOUISE S DAVIS RESIDENTIAL FACILITIES, LLC
Active
Other names
ANDOVER GROUP HOME
Organization subpart
No
Provider details
NPI number
Authorized official
KENDALL A BROUSSARD (MANAGING MEMBER)
(337) 439-6600
Entity
Organization
Contact information
Practice address
22336 SUTTER LN, ZACHARY, LA 70791-6003
(225) 654-3897
(225) 658-8396
Mailing address
1 LAKESHORE DR, SUITE 1900, LAKE CHARLES, LA 70629-0100
(337) 439-6600
(337) 439-6647
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
966
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1711071
—
LA
Enumeration date
03/22/2007
Last updated
10/08/2008
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