Provider Demographics
NPI:1215375159
Name:FAMILY SERVICE OF GREATER BATON ROUGE
Entity Type:Organization
Organization Name:FAMILY SERVICE OF GREATER BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-924-0123
Mailing Address - Street 1:4727 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3168
Mailing Address - Country:US
Mailing Address - Phone:225-924-0123
Mailing Address - Fax:225-924-5455
Practice Address - Street 1:4727 REVERE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3168
Practice Address - Country:US
Practice Address - Phone:225-924-0123
Practice Address - Fax:225-924-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4352251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1996190Medicaid