Healthcare Provider Details

I. General information

NPI: 1083002331
Provider Name (Legal Business Name): TWILIGHT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FLORIDA BLVD
BATON ROUGE LA
70806
US

IV. Provider business mailing address

3800 FLORIDA BLVD
BATON ROUGE LA
70806-3848
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-6700
  • Fax: 225-757-6711
Mailing address:
  • Phone: 225-757-6700
  • Fax: 225-757-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: CORDEL Y. PARRIS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 225-757-6700