Provider Demographics
NPI:1689890550
Name:RUSTON DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:RUSTON DEVELOPMENTAL CENTER
Other - Org Name:WESLEY CHAPEL COMMUNITY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTO OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-247-4213
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0907
Mailing Address - Country:US
Mailing Address - Phone:318-247-4204
Mailing Address - Fax:318-247-4254
Practice Address - Street 1:4372 HIGHWAY 818
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8339
Practice Address - Country:US
Practice Address - Phone:318-247-4204
Practice Address - Fax:318-247-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA944320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1711284Medicaid