Organization
WESTSIDE HABILITATION CENTER
Active
Parent organization
WESTSIDE HABILITATION CENTER
Other names
Fillmore Group Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTSIDE HABILITATION CENTER
Authorized official
MS. CHRISTINA B BOLTON (ADMINISTRATOR)
(318) 445-1551
Entity
Organization
Contact information
Practice address
1155 PRESIDENTS DRIVE, ALEXANDRIA, LA 71303
(318) 561-0255
(318) 561-0265
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
1018
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19G618
—
LA
Enumeration date
01/14/2008
Last updated
11/05/2009
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