Organization
NOVA VITAL IOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MALLORY MACISAAC (CONTROLLER)
(318) 268-6101
Entity
Organization
Contact information
Practice address
850 MARGARET PL, SHREVEPORT, LA 71101-4521
(318) 268-6101
Mailing address
8520 BUSINESS PARK DR, SHREVEPORT, LA 71105-5654
(318) 268-6101
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/08/2023
Last updated
04/05/2024
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