Organization
G B COOLEY MOORE RD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BEN PITTS (CHIEF EXECUTIVE OFFICER)
(318) 396-6300
Entity
Organization
Contact information
Practice address
612 MOORE RD, MONROE, LA 71202-7447
(318) 396-6300
(318) 397-9271
Mailing address
364 G B COOLEY ROAD, WEST MONROE, LA 71291-8800
(318) 396-6300
(318) 396-3660
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
657
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1719072
—
LA
Enumeration date
03/16/2007
Last updated
11/15/2018
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