Organization
NORMAL LIFE OF LAKE CHARLES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEENA OMBRES (PRIVACY OFFICER)
(502) 394-2387
Entity
Organization
Contact information
Practice address
3220 2ND AVE, LAKE CHARLES, LA 70601-8922
(337) 478-2299
Mailing address
9901 LINN STATION RD, LOUISVILLE, KY 40223-3808
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1569623
—
LA
05
—
1569631
—
LA
Enumeration date
05/22/2007
Last updated
01/06/2011
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