Provider Demographics
NPI:1700043254
Name:BOOKER T COMMUNITY OUTREACH INC
Entity Type:Organization
Organization Name:BOOKER T COMMUNITY OUTREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-6777
Mailing Address - Street 1:1411 SHERROUSE STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203
Mailing Address - Country:US
Mailing Address - Phone:318-325-6777
Mailing Address - Fax:318-325-6773
Practice Address - Street 1:1103 SHERROUSE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-5233
Practice Address - Country:US
Practice Address - Phone:318-325-6777
Practice Address - Fax:318-325-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health