Provider Demographics
NPI:1265732960
Name:CLASSIC CARE OF BATON ROUGE, INC.
Entity type:Organization
Organization Name:CLASSIC CARE OF BATON ROUGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-837-5557
Mailing Address - Street 1:PO BOX 6588
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6588
Mailing Address - Country:US
Mailing Address - Phone:504-837-5557
Mailing Address - Fax:504-833-3466
Practice Address - Street 1:1321 SIBLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-5100
Practice Address - Country:US
Practice Address - Phone:318-371-1801
Practice Address - Fax:318-371-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15368253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care