Provider Demographics
NPI:1003802745
Name:BAKER COMMUNITY MENTAL HEALTH CENTER,LLC
Entity Type:Organization
Organization Name:BAKER COMMUNITY MENTAL HEALTH CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-771-1510
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70704-0668
Mailing Address - Country:US
Mailing Address - Phone:225-771-1510
Mailing Address - Fax:225-771-1520
Practice Address - Street 1:2402 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-2322
Practice Address - Country:US
Practice Address - Phone:225-771-1510
Practice Address - Fax:225-771-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014945261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1335649Medicaid
LA1335649Medicaid
LA194667Medicare ID - Type Unspecified