Provider Demographics
NPI:1154683001
Name:WEST BATON ROUGE ADDICTION RECOVERY CENTER
Entity Type:Organization
Organization Name:WEST BATON ROUGE ADDICTION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:ALLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-776-0644
Mailing Address - Street 1:685 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2144
Mailing Address - Country:US
Mailing Address - Phone:225-776-0644
Mailing Address - Fax:225-687-5893
Practice Address - Street 1:685 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-776-0644
Practice Address - Fax:225-687-5893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST BATON ROUGE COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty