| NPI | 1104067255 |
|---|---|
| Other Name | LA BATON ROUGE 511002 |
| Entity Type | Organization |
| Authorized Contact | NATHAN RUSSELL PROVOST Controller 860-539-7745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2023-11-01 |