Organization
FAMILY LIFE DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALPHONSO BINGHAM (ADMINISTRATOR)
(318) 255-8405
Entity
Organization
Contact information
Practice address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
(318) 255-8405
Mailing address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
PCA 7222
LA
Other
Enumeration date
06/09/2010
Last updated
06/09/2010
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