| Mind Rehabilitation & Resource Center | |
|
1259 Fullilove Dr Bossier City LA 71112-3340 | |
| (318) 200-7859 | |
| Not Available |
| Full Name | Mind Rehabilitation & Resource Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1259 Fullilove Dr, Bossier City, Louisiana |
| Authorized Official Name and Position | Tonya M Riley (CLINICAL SUPERVISOR) |
| Authorized Official Contact | 3188281455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Rehabilitation & Resource Center 1259 Fullilove Dr Bossier City LA 71112-3340 Ph: (318) 200-7859 | Mind Rehabilitation & Resource Center 1259 Fullilove Dr Bossier City LA 71112-3340 Ph: (318) 200-7859 |
| NPI Number | 1972965556 |
|---|---|
| Provider Enumeration Date | 03/23/2016 |
| Last Update Date | 03/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972965556 | NPI | - | NPPES |
| 1851688105 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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