| La Baton Rouge 511002 | |
|
9467 Brookline Ave Baton Rouge LA 70809-1429 | |
| (225) 925-9780 | |
| (225) 925-8788 |
| Full Name | La Baton Rouge 511002 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9467 Brookline Ave, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Nathan Russell Provost (CONTROLLER) |
| Authorized Official Contact | 8605397745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Baton Rouge 511002 175 Addison Rd Ste 3 Windsor CT 06095-2179 Ph: (860) 539-7745 | La Baton Rouge 511002 9467 Brookline Ave Baton Rouge LA 70809-1429 Ph: (225) 925-9780 |
| NPI Number | 1104067255 |
|---|---|
| Provider Enumeration Date | 03/19/2009 |
| Last Update Date | 11/01/2023 |
| Certification Date | 11/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104067255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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