Provider Demographics
NPI:1790963189
Name:BAYOU STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:BAYOU STATE HEALTH SERVICES
Other - Org Name:ROBERTSON ROAD COMMUNITY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:COUTEE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-641-9900
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-1098
Mailing Address - Country:US
Mailing Address - Phone:318-641-9900
Mailing Address - Fax:318-641-9991
Practice Address - Street 1:550 ROBERTSON RD
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467-3800
Practice Address - Country:US
Practice Address - Phone:318-641-9900
Practice Address - Fax:318-641-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA810320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1713635Medicaid