| Supported Independent Living Prov Ider | |
|
132 Highway 850 Columbia LA 71418-1559 | |
| (318) 649-6097 | |
| (318) 649-2868 |
| Full Name | Supported Independent Living Prov Ider |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 132 Highway 850, Columbia, Louisiana |
| Authorized Official Name and Position | Michael Anthony Harrell (REGIONAL ASSOCIATE ADMINISTRATOR) |
| Authorized Official Contact | 3186496097 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supported Independent Living Prov Ider 132 Highway 850 Columbia LA 71418-1559 Ph: (318) 649-6097 | Supported Independent Living Prov Ider 132 Highway 850 Columbia LA 71418-1559 Ph: (318) 649-6097 |
| NPI Number | 1053531970 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053531970 | NPI | - | NPPES |
| 1159620 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SIL4246 (Louisiana) | Primary |
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