Provider Demographics
NPI:1861858516
Name:MILDRED EUAL CENTER INC
Entity Type:Organization
Organization Name:MILDRED EUAL CENTER INC
Other - Org Name:MECI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-349-0907
Mailing Address - Street 1:3018 OLD MINDEN RD STE 1117
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2497
Mailing Address - Country:US
Mailing Address - Phone:318-349-0907
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD STE 1117
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2497
Practice Address - Country:US
Practice Address - Phone:318-349-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health