Provider Demographics
NPI:1730680752
Name:RE-ENTRY SOLUTIONS
Entity Type:Organization
Organization Name:RE-ENTRY SOLUTIONS
Other - Org Name:INTEGRITY LIFE SKILLS & RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:CANDY
Authorized Official - Last Name:CHRISTOPHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:318-715-8179
Mailing Address - Street 1:1617 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4302
Mailing Address - Country:US
Mailing Address - Phone:318-443-0189
Mailing Address - Fax:318-767-1714
Practice Address - Street 1:1617 BRANCH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4302
Practice Address - Country:US
Practice Address - Phone:318-443-0189
Practice Address - Fax:318-767-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783745324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203783745Medicaid