Organization
CDF HEALTHCARE OF LA, LLC
Active
Other names
Sharkey Road Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE DEBOLT (ADMINISTRATOR)
(318) 878-5106
Entity
Organization
Contact information
Practice address
112 WALLACE RD, TALLULAH, LA 71282-7438
(318) 574-0455
Mailing address
PO BOX 607, DELHI, LA 71232-0607
(318) 878-5106
(318) 878-8671
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
977
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1719609
—
LA
Enumeration date
04/17/2007
Last updated
06/09/2010
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