Provider Demographics
NPI:1578623997
Name:FAMILY ROAD OF GREATER BATON ROUGE-NURSE FAMILY PARTNERSHIP
Entity Type:Organization
Organization Name:FAMILY ROAD OF GREATER BATON ROUGE-NURSE FAMILY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NFP SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:225-242-4865
Mailing Address - Street 1:323 E AIRPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4841
Mailing Address - Country:US
Mailing Address - Phone:225-201-8888
Mailing Address - Fax:225-925-1010
Practice Address - Street 1:323 E AIRPORT AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4841
Practice Address - Country:US
Practice Address - Phone:225-242-4865
Practice Address - Fax:225-342-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACW 5015251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462101Medicaid