Provider Demographics
NPI:1528207289
Name:AUDUBON OF BATON ROUGE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:AUDUBON OF BATON ROUGE HOME HEALTH, INC.
Other - Org Name:CYPRESS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-218-8009
Mailing Address - Street 1:9256 INTERLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1907
Mailing Address - Country:US
Mailing Address - Phone:225-218-8009
Mailing Address - Fax:225-218-0809
Practice Address - Street 1:3050 TEDDY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1980
Practice Address - Country:US
Practice Address - Phone:225-761-1592
Practice Address - Fax:225-928-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA975251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1402001Medicaid