Organization
JACKSON 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
325 MCKEITHEN DRIVE, ALEXANDRIA, LA 71303
(318) 473-0217
(318) 473-0256
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
814
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1713686
UNISYS
LA
Enumeration date
07/19/2006
Last updated
11/07/2009
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