Provider Demographics
NPI:1235369216
Name:FIRAT DIMENSIONS, INC
Entity type:Organization
Organization Name:FIRAT DIMENSIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR SHAPING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MADISE
Authorized Official - Suffix:
Authorized Official - Credentials:BSS
Authorized Official - Phone:985-385-1054
Mailing Address - Street 1:3115 ROSELAWN DR.
Mailing Address - Street 2:3115 ROSELAWN DR.
Mailing Address - City:MORGAN
Mailing Address - State:LA
Mailing Address - Zip Code:70380
Mailing Address - Country:US
Mailing Address - Phone:985-385-1054
Mailing Address - Fax:
Practice Address - Street 1:3115 ROSELAWN DR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1630
Practice Address - Country:US
Practice Address - Phone:985-385-1054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========Medicaid