Provider Demographics
NPI:1275050049
Name:RESILIENT HOUSE, LLC
Entity Type:Organization
Organization Name:RESILIENT HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:E
Authorized Official - Last Name:TURNBOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:318-469-1963
Mailing Address - Street 1:7020 KLUG PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3300
Mailing Address - Country:US
Mailing Address - Phone:318-606-5416
Mailing Address - Fax:
Practice Address - Street 1:7020 KLUG PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3300
Practice Address - Country:US
Practice Address - Phone:318-606-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility