Healthcare Provider Details

I. General information

NPI: 1669074159
Provider Name (Legal Business Name): LAROUGE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 AIRLINE HWY STE 233
BATON ROUGE LA
70816-8195
US

IV. Provider business mailing address

PO BOX 485
BAKER LA
70704-0485
US

V. Phone/Fax

Practice location:
  • Phone: 833-262-1101
  • Fax: 844-927-4527
Mailing address:
  • Phone: 225-955-1707
  • Fax: 225-341-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EBONY BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 833-262-1101