Provider Demographics
NPI:1205137197
Name:APPLEGATE RECOVERY LAKE CHARLES
Entity type:Organization
Organization Name:APPLEGATE RECOVERY LAKE CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-540-7184
Mailing Address - Street 1:617 W PRIEN LAKE RD
Mailing Address - Street 2:STE: L
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8386
Mailing Address - Country:US
Mailing Address - Phone:337-540-7184
Mailing Address - Fax:
Practice Address - Street 1:617 W PRIEN LAKE RD
Practice Address - Street 2:STE: L
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8386
Practice Address - Country:US
Practice Address - Phone:337-540-7184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service