Provider Demographics
NPI:1356066179
Name:AESTHETIC AND BREAST RESTORATIVE CENTER, LLC
Entity type:Organization
Organization Name:AESTHETIC AND BREAST RESTORATIVE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-290-2358
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-0732
Mailing Address - Country:US
Mailing Address - Phone:225-277-7200
Mailing Address - Fax:225-277-7205
Practice Address - Street 1:6330 MOURNING DOVE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1155
Practice Address - Country:US
Practice Address - Phone:225-277-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital