Organization
COMMUNITY BRIDGES SOUTH, INC.
Active
Other names
Lilinda Community Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE L. REYNOLDS (CEO)
(318) 255-1937
Entity
Organization
Contact information
Practice address
2600 S VIENNA ST, RUSTON, LA 71270-9026
(318) 255-1937
(318) 255-8233
Mailing address
2600 S VIENNA ST, RUSTON, LA 71270-9026
(318) 255-1937
(318) 255-8233
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
1034
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710334
—
LA
Enumeration date
02/27/2007
Last updated
08/22/2020
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