Provider Demographics
NPI:1699951509
Name:MONROE GROUP HOME
Entity type:Organization
Organization Name:MONROE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-1551
Mailing Address - Street 1:PO BOX 7917
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0917
Mailing Address - Country:US
Mailing Address - Phone:318-445-1551
Mailing Address - Fax:318-445-1242
Practice Address - Street 1:3902 JENNIFER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-2216
Practice Address - Country:US
Practice Address - Phone:318-448-4833
Practice Address - Fax:318-448-4834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE HABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-10
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1020315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19G620Medicaid