Provider Demographics
NPI:1992867063
Name:FAMILY SERVICE OF GREATER BATON ROUGE
Entity Type:Organization
Organization Name:FAMILY SERVICE OF GREATER BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-927-9810
Mailing Address - Street 1:4727 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3168
Mailing Address - Country:US
Mailing Address - Phone:225-927-9810
Mailing Address - Fax:225-927-9807
Practice Address - Street 1:4727 REVERE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3168
Practice Address - Country:US
Practice Address - Phone:225-927-9810
Practice Address - Fax:225-927-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM4201251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management