MEDICARE: COMPREHENSIVE INDEPENDENT GOALS 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	1157384	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881720837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE INDEPENDENT GOALS INC

Provider Business Mailing Address
First Line	:	PO BOX 66037
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70896-6037
Country	:	US
Telephone Number	:	225-926-5190
Fax Number	:	225-926-6964

Provider Business Practice Location Address
First Line	:	2138 WOODDALE BLVD
Second Line	:	STE. 3
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1443
Country	:	US
Telephone Number	:	225-926-5190
Fax Number	:	225-926-6964

Authorized Official
Title or Position	:	PRES. C.F.O.
Name	:	MR. RONNIE M MCGOWAN
Credential	:
Telephone Number	:	225-926-5190

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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