Provider Demographics
NPI:1326298522
Name:KEYS FOR SOBER LIVING
Entity Type:Organization
Organization Name:KEYS FOR SOBER LIVING
Other - Org Name:OPIATE REPLACEMENT THERAPY CENTERS OF AMERICA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA HOUSSAYE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:337-364-9094
Mailing Address - Street 1:132 W SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3743
Mailing Address - Country:US
Mailing Address - Phone:337-364-9094
Mailing Address - Fax:337-364-9071
Practice Address - Street 1:132 W SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3743
Practice Address - Country:US
Practice Address - Phone:337-364-9094
Practice Address - Fax:337-364-9071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPIATE REPLACEMENT THERAPY CENTERS OF AMERICA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA353, 353A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center