Organization
MONROE GROUP HOME
Active
Parent organization
WESTSIDE HABILITATION CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTSIDE HABILITATION CENTER
Authorized official
CHRISTINA B BOLTON (ADMINISTRATOR)
(318) 445-1551
Entity
Organization
Contact information
Practice address
3902 JENNIFER ST, ALEXANDRIA, LA 71302-2216
(318) 448-4833
(318) 448-4834
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
1020
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19G620
—
LA
Enumeration date
01/10/2008
Last updated
11/05/2009
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