Provider Demographics
NPI:1982730925
Name:COMPREHENSIVE INDEPENDENT GOALS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE INDEPENDENT GOALS INC
Other - Org Name:COMPREHENSIVE INDEPENDENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.C.F.O
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-926-5190
Mailing Address - Street 1:PO BOX 66037
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6037
Mailing Address - Country:US
Mailing Address - Phone:225-926-5190
Mailing Address - Fax:225-926-6964
Practice Address - Street 1:2138 WOODDALE BLVD
Practice Address - Street 2:STE. 3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1443
Practice Address - Country:US
Practice Address - Phone:225-926-5190
Practice Address - Fax:225-926-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1642649251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1642649Medicaid