Provider Demographics
NPI:1326565151
Name:COLLEGIATE BATON ROUGE
Entity Type:Organization
Organization Name:COLLEGIATE BATON ROUGE
Other - Org Name:NEW ORLEANS CHARTER SCIENCE AND MATH ACADEMY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-352-6438
Mailing Address - Street 1:1900 NORTH LOBDELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-892-6962
Mailing Address - Fax:
Practice Address - Street 1:1900 N LOBDELL BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-892-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ORLEANS CHARTER SCIENCE AND MATH A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA382005251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)