Organization Name: | AMIKIDS RED RIVER |
NPI Number: | 1013208669 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHY CANEVDAY (EXECUTIVE DIRECTOR) |
Mailing Address: | 2890 Douglas Drive Bossier City |
State: | LA US |
Postal Code: | 711115806 |
Phone Number: | 3187472224 |
Fax Number: | 3187474260 |
NPI Enumeration Date: | 04/29/2011 |
NPI Last Update Date: | 04/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |