Provider Demographics
NPI:1639483548
Name:COMPREHENSIVE INDEPENDENT GOALS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE INDEPENDENT GOALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-5190
Mailing Address - Street 1:2138 WOODDALE BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1443
Mailing Address - Country:US
Mailing Address - Phone:225-926-5190
Mailing Address - Fax:225-926-6964
Practice Address - Street 1:2138 WOODDALE BLVD
Practice Address - Street 2:STE 3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1443
Practice Address - Country:US
Practice Address - Phone:225-926-5190
Practice Address - Fax:225-926-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1642649Medicaid
LA1157384Medicaid
LA1157392Medicaid
LA1173835Medicaid