Provider Demographics
NPI:1982794962
Name:PALMETTO ADDICTION RECOVERY CENTER, INC
Entity Type:Organization
Organization Name:PALMETTO ADDICTION RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:HILBUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-728-2970
Mailing Address - Street 1:86 PALMETTO RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6415
Mailing Address - Country:US
Mailing Address - Phone:318-728-2970
Mailing Address - Fax:318-728-2272
Practice Address - Street 1:86 PALMETTO RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-6415
Practice Address - Country:US
Practice Address - Phone:318-728-2970
Practice Address - Fax:318-728-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA273324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility