Healthcare Provider Details

I. General information

NPI: 1942654686
Provider Name (Legal Business Name): COMMUNITY SCHOOL FOR APPRENTICESHIP LEARNING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4962 FLORIDA BLVD
BATON ROUGE LA
70806-4031
US

IV. Provider business mailing address

4962 FLORIDA BLVD
BATON ROUGE LA
70806-4031
US

V. Phone/Fax

Practice location:
  • Phone: 225-448-5399
  • Fax: 225-448-3695
Mailing address:
  • Phone: 225-448-5399
  • Fax: 225-448-3695

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 Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUJAN JOHNSON
Title or Position: CEO
Credential:
Phone: 225-448-5399