| Glenmora Sbhc | |
|
1414 7th Avenue Glenmora LA 71433 | |
| (318) 748-8974 | |
| (318) 748-8986 |
| Full Name | Glenmora Sbhc |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 1414 7th Avenue, Glenmora, Louisiana |
| Authorized Official Name and Position | Monte Wilson (CEO) |
| Authorized Official Contact | 3374702100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenmora Sbhc 3330 Masonic Dr Alexandria LA 71301-3841 Ph: (318) 483-4031 | Glenmora Sbhc 1414 7th Avenue Glenmora LA 71433 Ph: (318) 748-8974 |
| NPI Number | 1376664706 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 10/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376664706 | NPI | - | NPPES |
| 1446955 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | 234 (Louisiana) | Primary |
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