Provider Demographics
NPI:1548592918
Name:THE RECOVERY CENTER OF BATON ROUGE,LLC
Entity Type:Organization
Organization Name:THE RECOVERY CENTER OF BATON ROUGE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC CCS CCDPD
Authorized Official - Phone:225-927-7475
Mailing Address - Street 1:1680 LOBDELL AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8273
Mailing Address - Country:US
Mailing Address - Phone:225-927-7475
Mailing Address - Fax:225-927-7477
Practice Address - Street 1:1680 LOBDELL AVE STE E
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8273
Practice Address - Country:US
Practice Address - Phone:225-927-7475
Practice Address - Fax:225-927-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA432261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder