MEDICARE: NEW FAITH REHABILITATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	LA
2	101YM0800X	Mental Health Counselor	LA
3	101YP1600X	Pastoral Counselor	LA
4	261QM0850X	Adult Mental Health Clinic/Center	LA
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center	LA
6	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
7	302R00000X	Health Maintenance Organization	LA
8	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1801267547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW FAITH REHABILITATION

Provider Business Mailing Address
First Line	:	1755 WOODDALE BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1508
Country	:	US
Telephone Number	:	225-439-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 WOODDALE BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1508
Country	:	US
Telephone Number	:	225-439-1720
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBRA KENNEDY
Credential	:
Telephone Number	:	225-439-1720

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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Directions to “NEW FAITH REHABILITATION ” Practice Location

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