Provider Demographics
NPI:1912221201
Name:DOVE OUTREACH CENTER, INC.
Entity Type:Organization
Organization Name:DOVE OUTREACH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:225-326-1772
Mailing Address - Street 1:PO BOX 45371
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4371
Mailing Address - Country:US
Mailing Address - Phone:225-246-8824
Mailing Address - Fax:
Practice Address - Street 1:9445 SYBLE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-4053
Practice Address - Country:US
Practice Address - Phone:225-246-8824
Practice Address - Fax:225-246-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA145773104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3104A0625XMedicaid