Organization
POLK GROUP HOME
Active
Parent organization
WESTSIDE HABILITATION CENTER INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTSIDE HABILITATION CENTER INC
Authorized official
MS. CHRISTINA BONNETTE BOLTON (ADMINISTRATOR)
(318) 445-1551
Entity
Organization
Contact information
Practice address
557 MCKEITHEN DRIVE, ALEXANDRIA, LA 71303
(318) 473-0212
(318) 473-0117
Mailing address
PO BOX 7917, ALEXANDRIA, LA 71306-0917
(318) 445-1551
(318) 445-1242
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
815
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1713678
UNISYS
LA
05
—
19G531
—
LA
Enumeration date
07/13/2006
Last updated
11/07/2009
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