Organization
NORTHWEST SUPPORTS AND SERVICES CENTER
Active
Other names
Northwest Louisiana Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID COLVIN (ADMINISTRATOR)
(318) 741-5200
Entity
Organization
Contact information
Practice address
5401 SHED RD, BOSSIER CITY, LA 71111-5420
(318) 741-5230
(318) 741-5303
Mailing address
5401 SHED RD, BOSSIER CITY, LA 71111-5420
(318) 741-5230
(318) 741-5303
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
750000461
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1156752
—
LA
05
—
1156761
—
LA
05
—
1408182
—
LA
05
—
1567230
—
LA
05
—
1712035
—
LA
Enumeration date
02/09/2007
Last updated
02/27/2009
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