Provider Demographics
NPI:1083986210
Name:CHRISTIAN ACRES YOUTH CENTER
Entity Type:Organization
Organization Name:CHRISTIAN ACRES YOUTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-3146
Mailing Address - Street 1:200 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-2820
Mailing Address - Country:US
Mailing Address - Phone:318-574-3146
Mailing Address - Fax:318-574-4093
Practice Address - Street 1:200 BAILEY ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-2820
Practice Address - Country:US
Practice Address - Phone:318-574-3146
Practice Address - Fax:318-574-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9950322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children