Provider Demographics
NPI:1124371539
Name:NRLCL II
Entity Type:Organization
Organization Name:NRLCL II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CBIS, CCM
Authorized Official - Phone:985-875-3100
Mailing Address - Street 1:614 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3063
Mailing Address - Country:US
Mailing Address - Phone:985-875-3100
Mailing Address - Fax:985-875-3103
Practice Address - Street 1:804 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1446
Practice Address - Country:US
Practice Address - Phone:985-875-3100
Practice Address - Fax:985-875-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA003283X00000X, 3104A0630X, 320600000X, 320700000X, 324500000X, 385H00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes283X00000XHospitalsRehabilitation Hospital
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385H00000XRespite Care FacilityRespite Care