| Array Of Hope Outreach Center | |
|
11940 Bricksome Ave Ste C Baton Rouge LA 70816-2594 | |
| (225) 250-5829 | |
| (225) 250-5879 |
| Full Name | Array Of Hope Outreach Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 11940 Bricksome Ave Ste C, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Demetrice Marie Clark (ADMINISTRATOR) |
| Authorized Official Contact | 2252531277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Array Of Hope Outreach Center 11940 Bricksome Ave Ste C Baton Rouge LA 70816-2594 Ph: (225) 250-5829 | Array Of Hope Outreach Center 11940 Bricksome Ave Ste C Baton Rouge LA 70816-2594 Ph: (225) 250-5829 |
| NPI Number | 1194173005 |
|---|---|
| Provider Enumeration Date | 06/01/2016 |
| Last Update Date | 11/02/2023 |
| Certification Date | 11/02/2023 |
| Medicare PECOS PAC ID | 6709222490 |
|---|---|
| Medicare Enrollment ID | O20240316000543 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194173005 | NPI | - | NPPES |
| Provider Name | Demetrice Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528430550 PECOS PAC ID: 7517303209 Enrollment ID: I20240423003010 |
| Provider Name | Quayila M Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982079901 PECOS PAC ID: 1557700523 Enrollment ID: I20240424000228 |
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