Provider Demographics
NPI:1487373973
Name:CUP WITH A TWIST OF COCOA
Entity type:Organization
Organization Name:CUP WITH A TWIST OF COCOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-254-6809
Mailing Address - Street 1:411 WALL ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3029
Mailing Address - Country:US
Mailing Address - Phone:337-254-6890
Mailing Address - Fax:
Practice Address - Street 1:411 WALL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3029
Practice Address - Country:US
Practice Address - Phone:337-254-6890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUP WITH A TWIST OF COCOA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility