Provider Demographics
NPI:1114561016
Name:ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Entity Type:Organization
Organization Name:ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6443
Mailing Address - Street 1:PO BOX 7768
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0768
Mailing Address - Country:US
Mailing Address - Phone:318-445-6443
Mailing Address - Fax:318-449-8520
Practice Address - Street 1:6715 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409-9221
Practice Address - Country:US
Practice Address - Phone:318-445-6443
Practice Address - Fax:318-449-8520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMR0012567OtherLOUISIANA DEPT OF HEALTH-STATE ID NO.