Provider Demographics
NPI:1952757023
Name:CANE RIVER CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:CANE RIVER CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:FALLON
Authorized Official - Middle Name:DAI
Authorized Official - Last Name:O'BANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RSW
Authorized Official - Phone:318-208-0043
Mailing Address - Street 1:425 RUE DE GABRIEL
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-8243
Mailing Address - Country:US
Mailing Address - Phone:318-352-9349
Mailing Address - Fax:318-352-9345
Practice Address - Street 1:425 RUE DE GABRIEL
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-8243
Practice Address - Country:US
Practice Address - Phone:318-352-9349
Practice Address - Fax:318-352-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness