Provider Demographics
NPI:1285193185
Name:BODY & SOUL SERVICES, INC.
Entity Type:Organization
Organization Name:BODY & SOUL SERVICES, INC.
Other - Org Name:BODY & SOUL REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, VP
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:318-283-3299
Mailing Address - Street 1:511 GUNBY AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4407
Mailing Address - Country:US
Mailing Address - Phone:318-283-3299
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY & SOUL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-19
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty