Provider Demographics
NPI:1184841488
Name:SHEKINAH GLORY MINISTRY OF BATON ROUGE
Entity Type:Organization
Organization Name:SHEKINAH GLORY MINISTRY OF BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-924-4575
Mailing Address - Street 1:PO BOX 53766
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70892-3766
Mailing Address - Country:US
Mailing Address - Phone:225-924-4575
Mailing Address - Fax:225-924-4574
Practice Address - Street 1:3613 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5721
Practice Address - Country:US
Practice Address - Phone:225-346-5225
Practice Address - Fax:225-346-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 12514320600000X
LAPCA 12390320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351407Medicaid