Organization
MIND REHABILITATION AND RESOURCE CENTER
Active
Organization
MIND REHABILITATION AND RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEN CHINWEZE CEO (OWNER)
(318) 828-1455
Entity
Organization
Contact information
Practice address
1513 LINE AVE, SUITE 135, SHREVEPORT, LA 71101-4621
(318) 828-1455
Mailing address
1513 LINE AVE, SUITE 135, SHREVEPORT, LA 71101-4621
(318) 828-1455
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YM0800X
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2154869
—
LA
Enumeration date
01/20/2016
Last updated
01/20/2016
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