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Organization

PEACOCK ADDICTION TREATMENT & HEALING (PATH) CENTER LLC

Active
Other names
Peacock LifeCare
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JO LYNN BENNETT APRN (OWNER)
(318) 334-5825
Entity
Organization

Contact information

Practice address
1401 LOUISA ST, RAYVILLE, LA 71269-3245
(318) 303-4632
(318) 301-6826
Mailing address
437 OVERLAN STAGE RD, RAYVILLE, LA 71269-7655
(318) 334-5825
(318) 301-6826

Taxonomy

Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
261Q00000X
Clinic/Center
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Enumeration date
08/24/2024
Last updated
08/24/2024
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