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Provincial Community Home Inc
Intellectual Disabilities Intermediate Care Facility in Mansfield, Louisiana
NPI 1780894477

Provincial Community Home Inc is a Intellectual Disabilities Intermediate Care Facility based in Mansfield, LA. Provincial Community Home Inc practices in Mansfield, LA. The NPI Number for Provincial Community Home Inc is 1780894477 and holds a License No. 636 (Louisiana).

The current practice location address for Provincial Community Home Inc is 167 Poole Road, Mansfield, LA and can be reached out via phone at 318-872-0206 and via fax at 318-872-8833.

Location: 167 Poole Road, Mansfield, LA, 71052-5007
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1780894477
Provider Name
Provincial Community Home Inc
Credential
Provider Entity Type
Organization
Address
167 Poole Road, Mansfield, LA, 71052-5007
Phone Number
318-872-0206
Fax Number
318-872-8833
Provider Enumeration Date
05/23/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1718971 05 LA
institution
Provider Business Practice Location Address Details
Address
167 Poole Road
City
Mansfield
State
Louisiana
Zip
71052-5007
Phone Number
318-872-0206
Fax Number
318-872-8833
person
Provider Business Mailing Address Details
Address
167 Poole Road
City
Mansfield
State
Louisiana
Zip
71052-5007
Phone Number
318-872-0206
Fax Number
318-872-8833
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
636 (Louisiana)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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