Provider Demographics
NPI:1689790909
Name:ST. JOHN THE BAPTIST, HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:ST. JOHN THE BAPTIST, HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:WAGUESPACK
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-216-1199
Mailing Address - Street 1:7732 GOODWOOD BLVD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7626
Mailing Address - Country:US
Mailing Address - Phone:225-216-1199
Mailing Address - Fax:225-216-1194
Practice Address - Street 1:7732 GOODWOOD BLVD
Practice Address - Street 2:SUITE A-1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7626
Practice Address - Country:US
Practice Address - Phone:225-216-1199
Practice Address - Fax:225-216-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 8037251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1663921Medicaid