Provider Demographics
NPI:1578014387
Name:HOLY ANGELS RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:HOLY ANGELS RESIDENTIAL FACILITY
Other - Org Name:HOLY ANGELS AUTISM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LANDRY
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
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:318-797-0801
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:318-797-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2431641Medicaid
LA1316165418Medicaid
LA1528287299Medicaid
LA1164641833Medicaid
LA1225256035Medicaid
LA1770750747Medicaid
LA1346469012Medicaid
LA1437378106Medicaid
LA1184843849Medicaid
LA1497173090Medicaid
LA1619196383Medicaid
LA1992924658Medicaid
LA1073732749Medicaid
LA1861747636Medicaid
LA1982823654Medicaid