Organization
NORTHLAKE SUPPORTS AND SERVICES CENTER
Active
Parent organization
NORTHLAKE SUPPORTS AND SERVICES CENTER
Other names
Ivy Springs Community Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHLAKE SUPPORTS AND SERVICES CENTER
Authorized official
MR. RONALD WILLIAMS (ADMINISTRATOR)
(225) 567-3111
Entity
Organization
Contact information
Practice address
27683 IVY SPRINGS DRIVE, INDEPENDENCE, LA 70443
(225) 567-3111
Mailing address
45439 LIVE OAK DR, HAMMOND, LA 70401-4526
(225) 567-3111
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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