Provider Demographics
NPI:1881303428
Name:LONDON'S BOARDING HOME, RECREATION, & REHAB TRAINING FACILITIES, INC
Entity type:Organization
Organization Name:LONDON'S BOARDING HOME, RECREATION, & REHAB TRAINING FACILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LONDON
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-658-4932
Mailing Address - Street 1:4822 WAYWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-658-4932
Mailing Address - Fax:225-658-4928
Practice Address - Street 1:4822 WAYWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-658-4932
Practice Address - Fax:225-658-4928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONDON'S BOARDING HOME, RECREATION, & REHAB TRAINING FACILITIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131768Medicaid
LA1722804Medicaid
LA1461601Medicaid