Provider Demographics
NPI:1407094253
Name:LOUISIANA RE-ENTRY & REHABILITATION SERVICES- WEST MONROE
Entity Type:Organization
Organization Name:LOUISIANA RE-ENTRY & REHABILITATION SERVICES- WEST MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DUVON
Authorized Official - Last Name:STEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-247-2499
Mailing Address - Street 1:1301 THOMAS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-5816
Mailing Address - Country:US
Mailing Address - Phone:318-322-3349
Mailing Address - Fax:318-322-3855
Practice Address - Street 1:1301 THOMAS RD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-5816
Practice Address - Country:US
Practice Address - Phone:318-322-3349
Practice Address - Fax:318-322-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1104251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA653435WMOtherMHSD