Organization Name: | BROADLANDS FAMILY SERVICES, LLC |
NPI Number: | 1063866432 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RON DANTIN (PROVIDER) |
Mailing Address: | 14791 E Main St Cut Off |
State: | LA US |
Postal Code: | 703452658 |
Phone Number: | 9856322569 |
Fax Number: | 9853258668 |
NPI Enumeration Date: | 04/21/2016 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3284 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |