Organization
MIND REHABILITATION AND RESOURCE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN AKACHUKWU CHINWEZE (ADMINISTRATOR)
(713) 553-5863
Entity
Organization
Contact information
Practice address
6009 FINANCIAL PLZ STE 102, SHREVEPORT, LA 71129-2615
(318) 828-1455
Mailing address
6009 FINANCIAL PLZ STE 102, SHREVEPORT, LA 71129-2615
(318) 828-1455
(318) 828-1626
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
LA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154547578
—
LA
05
—
1194941518
—
LA
05
—
1194941526
—
LA
05
—
1245456664
—
LA
05
—
1427274851
—
LA
05
—
1447474135
—
LA
05
—
1629294053
—
LA
05
—
1841414489
—
LA
Enumeration date
07/07/2011
Last updated
07/08/2023
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