Provider Demographics
NPI:1346412830
Name:NEAL W.ANGRUM
Entity Type:Organization
Organization Name:NEAL W.ANGRUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:ANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-450-1478
Mailing Address - Street 1:408 THATCHER LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6516
Mailing Address - Country:US
Mailing Address - Phone:318-450-1478
Mailing Address - Fax:318-651-9107
Practice Address - Street 1:10249 HWY 67
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-3997
Practice Address - Fax:318-651-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1409456252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency