Provider Demographics
NPI:1356015655
Name:SERENITY SQUARE OF BATON ROUGE CORP.
Entity Type:Organization
Organization Name:SERENITY SQUARE OF BATON ROUGE CORP.
Other - Org Name:AGELESS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-254-1026
Mailing Address - Street 1:1353 SURREY ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7617
Mailing Address - Country:US
Mailing Address - Phone:337-254-1026
Mailing Address - Fax:
Practice Address - Street 1:11238 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2014
Practice Address - Country:US
Practice Address - Phone:225-831-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care