Organization
THE EXTRA MILE, REGION IV, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA C BOUDREAUX (EXECUTIVE DIRECTOR)
(337) 237-2090
Entity
Organization
Contact information
Practice address
525 S BUCHANAN ST, LAFAYETTE, LA 70501-6815
(337) 237-2090
(337) 237-2083
Mailing address
525 S BUCHANAN ST, LAFAYETTE, LA 70501-6815
(337) 237-2090
(337) 237-2083
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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