Organization
AGELESS INDEPENDENCE CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN CAILLIER (DIRECTOR)
(337) 654-5519
Entity
Organization
Contact information
Practice address
1011 SURREY ST, LAFAYETTE, LA 70501-6142
(337) 654-5519
Mailing address
500 SURREY ST, LAFAYETTE, LA 70501-6134
(337) 654-5519
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/02/2010
Last updated
08/02/2010
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