Provider Demographics
NPI:1255665832
Name:BATON ROUGE PRIMARY CARE COLLABORATIVE, INC.
Entity Type:Organization
Organization Name:BATON ROUGE PRIMARY CARE COLLABORATIVE, INC.
Other - Org Name:ST. VINCENT DE PAUL HOMELESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:225-774-1120
Mailing Address - Street 1:2013 CENTRAL ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-3918
Mailing Address - Country:US
Mailing Address - Phone:225-774-1120
Mailing Address - Fax:225-774-1158
Practice Address - Street 1:2013 CENTRAL RD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-3944
Practice Address - Country:US
Practice Address - Phone:225-774-1120
Practice Address - Fax:225-774-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)