Provider Demographics
NPI:1649406968
Name:ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Entity Type:Organization
Organization Name:ST. MARY'S RESIDENTIAL TRAINING SCHOOL
Other - Org Name:FR. AUGUST THOMPSON HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-6443
Mailing Address - Street 1:PO BOX 7768
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0768
Mailing Address - Country:US
Mailing Address - Phone:318-445-6443
Mailing Address - Fax:318-449-8520
Practice Address - Street 1:6715 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409-9221
Practice Address - Country:US
Practice Address - Phone:318-445-6443
Practice Address - Fax:318-449-8520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FR. AUGUST THOMPSON HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1037320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities