Provider Demographics
NPI:1497408892
Name:YOUTH OF EXCELLENCE OF LA RECREATION CENTER
Entity type:Organization
Organization Name:YOUTH OF EXCELLENCE OF LA RECREATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-341-3487
Mailing Address - Street 1:1715 FILHIOL AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3407
Mailing Address - Country:US
Mailing Address - Phone:318-341-3487
Mailing Address - Fax:
Practice Address - Street 1:1015 N AREY ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-2003
Practice Address - Country:US
Practice Address - Phone:318-341-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH OF EXCELLENCE OF LOUISIANA C/O MARY WATSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness