Northlake Supports and Services Center
Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Independence, LA
NPI 1710150446 · NPPES record last updated Apr 2, 2008
Key facts
- NPI
- 1710150446
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- Legal business name
- NORTHLAKE SUPPORTS AND SERVICES CENTER
- Practice address
- 27683 Ivy Springs Drive
Independence, LA 70443 - Phone
- (225) 567-3111
- NPI assigned
- Apr 2, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTHLAKE SUPPORTS AND SERVICES CENTER
Authorized official
- Name
- Mr. Ronald Williams
- Title
- Administrator
- Phone
- (225) 567-3111
Corporate family (same tax ID) 11
National Provider Directory
- Tax ID family
- Rene Drive Community Home
- Part of
- Rene Drive Community Home
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | Yes |
Addresses
Primary practice location
27683 Ivy Springs Drive
Independence, LA 70443
Mailing address
45439 Live Oak Dr
Hammond, LA 70401-4526
Phone (225) 567-3111
Other names
- Ivy Springs Community Home
Other providers in Independence, LA
- Tashawn L. Mustiful
- Marshall Reid Naquin
- Suhail Naseri
- Nes Louisiana, Inc.
- Normal Life of Louisiana, Inc.
- Northwest Medical Supplies
- Amanda M Olinde
- On Time Moving and Transportation LLC
- Eugene Gary Oppman
- Jacqueline Reynolds Overton
All providers in Independence, LA · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.