Provider Demographics
NPI:1821318221
Name:BOOKER T COMMUNITY OUTREACH PROJECT
Entity Type:Organization
Organization Name:BOOKER T COMMUNITY OUTREACH PROJECT
Other - Org Name:THE JOHN BREAUX ASSISTED LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-489-5300
Mailing Address - Street 1:1411 SHERROUSE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-5435
Mailing Address - Country:US
Mailing Address - Phone:318-489-5900
Mailing Address - Fax:318-934-0097
Practice Address - Street 1:1411 SHERROUSE STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-489-5300
Practice Address - Fax:318-934-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital