NPIMap

Organization Active NPI

Miracle Outlook Family Services

  • Developmentally Disabled Services Day Training Agency
  • Monroe, LA
National Provider Identifier
1003090317
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
10403 Issued in LA
Legal business name
MIRACLE OUTLOOK FAMILY SERVICES
Practice address
2404 Ferrand St.
Suite 21
Monroe, LA 71201-4954
Phone
(318) 324-0048
NPI assigned
Dec 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rgina Lynn Jackson
Title
Owner
Phone
(318) 324-0048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 10403 LA Primary

Addresses

Primary practice location

2404 Ferrand St.
Suite 21
Monroe, LA 71201-4954

Mailing address

2404 Ferrand St
Suite 21
Monroe, LA 71201-3234
Phone (318) 324-0048

Other identifiers 1

IdentifierTypeStateIssuer
1017639MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Miracle Outlook Family Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2404 Ferrand St
Ste 21
Monroe, LA 71201
Phone (318) 324-0048

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1003090317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 FERRAND ST",
            "address_2": "SUITE 21",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013234",
            "telephone_number": "318-324-0048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 FERRAND ST.",
            "address_2": "SUITE 21",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712014954",
            "telephone_number": "318-324-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE OUTLOOK FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RGINA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-324-0048"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "LA",
            "license": "10403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017639",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.