Provider Demographics
NPI:1417232307
Name:CUTTING EDGE HEALTHCARE
Entity Type:Organization
Organization Name:CUTTING EDGE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLABORATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-952-8296
Mailing Address - Street 1:5316 TRENTS PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1332
Mailing Address - Country:US
Mailing Address - Phone:225-615-7050
Mailing Address - Fax:
Practice Address - Street 1:5316 TRENTS PL
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1332
Practice Address - Country:US
Practice Address - Phone:225-615-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN106698-AP066673104A0630X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances