Provider Demographics
NPI:1518379833
Name:GRIEF RECOVERY CENTER
Entity Type:Organization
Organization Name:GRIEF RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-924-6621
Mailing Address - Street 1:4939 JAMESTOWN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3229
Mailing Address - Country:US
Mailing Address - Phone:225-924-6621
Mailing Address - Fax:225-924-6627
Practice Address - Street 1:4939 JAMESTOWN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3229
Practice Address - Country:US
Practice Address - Phone:225-924-6621
Practice Address - Fax:225-924-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CX31Medicare PIN