Provider Demographics
NPI:1477633014
Name:HOLY ANGELS RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:HOLY ANGELS RESIDENTIAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SR. CONCETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIPIONE
Authorized Official - Suffix:
Authorized Official - Credentials:OLS
Authorized Official - Phone:318-797-8500
Mailing Address - Street 1:10450 ELLERBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7712
Mailing Address - Country:US
Mailing Address - Phone:318-797-8500
Mailing Address - Fax:318-797-8599
Practice Address - Street 1:10450 ELLERBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7712
Practice Address - Country:US
Practice Address - Phone:318-797-8500
Practice Address - Fax:318-797-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA124320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities