Provider Demographics
NPI:1497150940
Name:LOVE VILLAGE OF OUACHITA
Entity Type:Organization
Organization Name:LOVE VILLAGE OF OUACHITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:DENEICE
Authorized Official - Last Name:AUGURSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-235-9203
Mailing Address - Street 1:4463 WINNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-7509
Mailing Address - Country:US
Mailing Address - Phone:318-235-9203
Mailing Address - Fax:
Practice Address - Street 1:4463 WINNSBORO RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-7509
Practice Address - Country:US
Practice Address - Phone:318-235-9203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness