Provider Demographics
NPI:1437554904
Name:COGNITIVE DEVELOPMENT CTR PERSONAL CARE SERVIES
Entity type:Organization
Organization Name:COGNITIVE DEVELOPMENT CTR PERSONAL CARE SERVIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-651-8080
Mailing Address - Street 1:PO BOX 7563
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-7563
Mailing Address - Country:US
Mailing Address - Phone:318-651-8080
Mailing Address - Fax:318-651-8081
Practice Address - Street 1:1811 ROSELAWN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5433
Practice Address - Country:US
Practice Address - Phone:318-651-8080
Practice Address - Fax:318-651-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10839253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care