Provider Demographics
NPI:1609051127
Name:EXTENDED FAMILY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:EXTENDED FAMILY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LATHAN
Authorized Official - Last Name:BATISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/MA
Authorized Official - Phone:225-923-0203
Mailing Address - Street 1:1970 FLORIDA AVE SW
Mailing Address - Street 2:D
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4948
Mailing Address - Country:US
Mailing Address - Phone:225-664-0401
Mailing Address - Fax:225-923-0207
Practice Address - Street 1:9441 COMMON ST
Practice Address - Street 2:B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1463
Practice Address - Country:US
Practice Address - Phone:225-923-0203
Practice Address - Fax:225-923-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20021Medicaid