MEDICARE: THE POTTERS HOUSE COMMUNITY SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	5124	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1697699	OTHER	LA	PCA

General Provider Information

NPI Number	:	1598882375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE POTTERS HOUSE COMMUNITY SERVICES INC.

Provider Business Mailing Address
First Line	:	1986 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1400
Country	:	US
Telephone Number	:	225-927-0600
Fax Number	:	225-927-6544

Provider Business Practice Location Address
First Line	:	1986 DALLAS DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1400
Country	:	US
Telephone Number	:	225-927-0600
Fax Number	:	225-927-6544

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GERALDINE JUNIUS
Credential	:
Telephone Number	:	225-927-0600

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	08/22/2020

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