Provider Demographics
NPI:1750410684
Name:NEAL W.ANGRUM
Entity type:Organization
Organization Name:NEAL W.ANGRUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECT OWNER
Authorized Official - Phone:318-450-1478
Mailing Address - Street 1:408 THATCHER LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6516
Mailing Address - Country:US
Mailing Address - Phone:318-450-1478
Mailing Address - Fax:318-651-9107
Practice Address - Street 1:10249 HWY.67
Practice Address - Street 2:SUITE1
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-3997
Practice Address - Fax:318-651-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7086,7087,7088251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4506157Medicaid