Provider Demographics
NPI:1568656379
Name:ST MARYS RESD TRAINING SCHOOL
Entity Type:Organization
Organization Name:ST MARYS RESD TRAINING SCHOOL
Other - Org Name:STUCKEY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6443
Mailing Address - Street 1:PO DRAWER 7768
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306
Mailing Address - Country:US
Mailing Address - Phone:318-445-6443
Mailing Address - Fax:318-449-8520
Practice Address - Street 1:6725 HWY 1 NORTH
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409
Practice Address - Country:US
Practice Address - Phone:318-443-9372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARYS RESD TRAINING SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA928315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1711233Medicaid