Provider Demographics
NPI:1164748596
Name:NOVICE HOUSE OF BATON ROUGE, INC.
Entity Type:Organization
Organization Name:NOVICE HOUSE OF BATON ROUGE, INC.
Other - Org Name:FAMILY SERVICES UNLIMITED, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-923-1044
Mailing Address - Street 1:11616 SOUTHFORK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5241
Mailing Address - Country:US
Mailing Address - Phone:225-291-9718
Mailing Address - Fax:225-291-9692
Practice Address - Street 1:11616 SOUTHFORK AVE STE 203
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5241
Practice Address - Country:US
Practice Address - Phone:225-291-9718
Practice Address - Fax:225-291-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720433Medicaid