Basic Information
| Provider Information | |||||||||
| NPI: | 1831676170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISIANA UNITED METHODIST CHILDREN AND FAMILY SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OWL EQUINE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 DEVILLE LN | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712706313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182555020 | ||||||||
| FaxNumber: | 3182556623 | ||||||||
| Practice Location | |||||||||
| Address1: | 1523 HIGHWAY 563 | ||||||||
| Address2: | |||||||||
| City: | DUBACH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187773460 | ||||||||
| FaxNumber: | 3187779377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YATES | ||||||||
| AuthorizedOfficialFirstName: | JAN | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR HEALTH INFO. MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 3182555020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LOUISIANA UNITED METHODIST CHILDREN AND FAMILY SERVICES, INC. | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.