| The Extra Mile, Region Iv, Inc. | |
|
525 S Buchanan St Lafayette LA 70501-6815 | |
| (337) 237-2090 | |
| (337) 237-2083 |
| Full Name | The Extra Mile, Region Iv, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 525 S Buchanan St, Lafayette, Louisiana |
| Authorized Official Name and Position | Linda C Boudreaux (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3372372090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Extra Mile, Region Iv, Inc. 525 S Buchanan St Lafayette LA 70501-6815 Ph: (337) 237-2090 | The Extra Mile, Region Iv, Inc. 525 S Buchanan St Lafayette LA 70501-6815 Ph: (337) 237-2090 |
| NPI Number | 1962777268 |
|---|---|
| Provider Enumeration Date | 03/20/2012 |
| Last Update Date | 03/20/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962777268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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