Provider Demographics
NPI:1003075870
Name:BODY & SOUL SERVICES INC
Entity Type:Organization
Organization Name:BODY & SOUL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-376-1113
Mailing Address - Street 1:803 BRISCO AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5161
Mailing Address - Country:US
Mailing Address - Phone:318-283-3299
Mailing Address - Fax:318-283-3298
Practice Address - Street 1:803 BRISCO AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5161
Practice Address - Country:US
Practice Address - Phone:318-283-3299
Practice Address - Fax:318-283-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 7233251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1004375Medicaid