Provider Demographics
NPI:1144224031
Name:CEREBRAL PALSY ASSOCIATION OF G.B.R., INC.
Entity Type:Organization
Organization Name:CEREBRAL PALSY ASSOCIATION OF G.B.R., INC.
Other - Org Name:MCMAINS CHILDREN'S DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:KETCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-923-3420
Mailing Address - Street 1:1805 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1919
Mailing Address - Country:US
Mailing Address - Phone:225-923-3420
Mailing Address - Fax:225-922-9316
Practice Address - Street 1:1805 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1919
Practice Address - Country:US
Practice Address - Phone:225-923-3420
Practice Address - Fax:225-922-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1394149Medicaid
LA02587OtherBLUE CROSS PROVIDER
LA1930423Medicaid
LA02587OtherBLUE CROSS PROVIDER