Provider Demographics
NPI:1376222901
Name:JOVIN HEALTHCARE AND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:JOVIN HEALTHCARE AND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:EDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-256-4764
Mailing Address - Street 1:7715 TOM DR STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2321
Mailing Address - Country:US
Mailing Address - Phone:225-256-4764
Mailing Address - Fax:225-960-1323
Practice Address - Street 1:7715 TOM DR STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2321
Practice Address - Country:US
Practice Address - Phone:225-806-3732
Practice Address - Fax:337-643-8407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUDY EDO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2474260Medicaid