| Na | |
|
6220 Florida Blvd Ste D Baton Rouge LA 70806-4556 | |
| (225) 810-3885 | |
| (833) 810-3885 |
| Full Name | Na |
|---|---|
| Speciality | Clinic/Center |
| Location | 6220 Florida Blvd Ste D, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Jaliah Pabon (ADMINISTRATOR) |
| Authorized Official Contact | 2258103885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 6220 Florida Blvd Ste D Baton Rouge LA 70806-4556 Ph: (225) 810-3885 | Na 6220 Florida Blvd Ste D Baton Rouge LA 70806-4556 Ph: (225) 810-3885 |
| NPI Number | 1033738562 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 07/18/2023 |
| Certification Date | 07/18/2023 |
| Medicare PECOS PAC ID | 5991126047 |
|---|---|
| Medicare Enrollment ID | O20200528002125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033738562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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