Organization
COMMUNITY BRIDGES SOUTH
Active
Other names
Benton Street Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L REYNOLDS (CEO)
(318) 255-1937
Entity
Organization
Contact information
Practice address
1400 BENTON ST, RUSTON, LA 71270-5404
(318) 255-1937
(318) 255-8233
Mailing address
PO BOX 715, RUSTON, LA 71273-0715
(318) 255-1937
(318) 255-8233
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
1010
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710008
—
LA
Enumeration date
02/26/2007
Last updated
08/22/2020
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