Organization
MIRROR OF GRACE OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA ANN HARREL (EXECUTIVE DIRECTOR)
(225) 300-4528
Entity
Organization
Contact information
Practice address
921 LOBDELL BLVD, SUITE E, BATON ROUGE, LA 70806-8811
(225) 300-4528
Mailing address
921 LOBDELL BLVD, SUITE E, BATON ROUGE, LA 70806-8811
(225) 892-9514
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MS40353488N
LOUISIANA SECRETARY OF STATE
LA
Enumeration date
03/06/2014
Last updated
07/21/2022
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