Provider Demographics
NPI:1801402433
Name:HIV-AIDS ALLIANCE FOR REGION TWO
Entity Type:Organization
Organization Name:HIV-AIDS ALLIANCE FOR REGION TWO
Other - Org Name:OPEN HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-424-1800
Mailing Address - Street 1:9516 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5501
Mailing Address - Country:US
Mailing Address - Phone:225-655-6422
Mailing Address - Fax:225-341-5903
Practice Address - Street 1:30789 N RANGE AVENUE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:225-655-6422
Practice Address - Fax:225-341-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)