1235312893 NPI number — ST MARYS RESIDENTIAL TRAINING SCHOOL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235312893 NPI number — ST MARYS RESIDENTIAL TRAINING SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST MARYS RESIDENTIAL TRAINING SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235312893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 7768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-445-6443
Provider Business Mailing Address Fax Number:
318-449-8520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6719 HWY 1 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-473-0243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERTANI
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
318-445-6443

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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