Provider Demographics
NPI:1477013183
Name:RL TRAYLOR ENTERPRISES, LLC
Entity type:Organization
Organization Name:RL TRAYLOR ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-791-3427
Mailing Address - Street 1:209 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7067
Mailing Address - Country:US
Mailing Address - Phone:318-600-6273
Mailing Address - Fax:318-600-6274
Practice Address - Street 1:1100 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2804
Practice Address - Country:US
Practice Address - Phone:318-600-6274
Practice Address - Fax:318-600-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities