Provider Demographics
NPI:1629939343
Name:HOLY ANGELS RESIDENTIAL FACILITY
Entity type:Organization
Organization Name:HOLY ANGELS RESIDENTIAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:318-629-1737
Mailing Address - Street 1:10450 ELLERBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7730
Mailing Address - Country:US
Mailing Address - Phone:318-629-1737
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:71106-7730
Practice Address - Country:US
Practice Address - Phone:318-629-1737
Practice Address - Fax:318-797-0801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY ANGELS RESIDENTIAL FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services