Organization
FAMILY LIFE DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALPHONSO BINGHAM (ADMINISTRATOR)
(318) 255-8405
Entity
Organization
Contact information
Practice address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
(318) 255-8405
Mailing address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
(318) 255-8405
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015482
—
LA
Enumeration date
05/29/2008
Last updated
05/29/2008
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