Organization
SANCTUARY LOUISIANA LLC
Active
Parent organization
SANCTUARY LOUISIANA LLC
Other names
SANCTUARY OF LOUISIANA CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SANCTUARY LOUISIANA LLC
Authorized official
KELVIN SMITH (ADMINISTRATOR)
(337) 936-9197
Entity
Organization
Contact information
Practice address
21089 SOUTH FRONTAGE ROAD, LACASSINE, LA 70650-9998
(337) 936-9197
(337) 588-4179
Mailing address
PO BOX 1967, IOWA, LA 70647-1967
(337) 936-9197
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
207RR0500X
Rheumatology Physician
—
—
208D00000X
General Practice Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/13/2020
Last updated
08/29/2023
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