Organization
SOUTHWEST LA DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL K MCDANIEL (MR/DD REGIONAL ADMINISTRATOR)
(337) 824-6250
Entity
Organization
Contact information
Practice address
224 GREMILLION CIRCLE, IOTA, LA 70543
(337) 824-6250
(337) 821-9306
Mailing address
224 GREMILLION CIRCLE, IOTA, LA 70543
(337) 824-6250
(337) 821-9306
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
13532
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102695
CHILD PLACING FOSTER CARE
LA
Enumeration date
07/30/2007
Last updated
07/30/2007
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