Healthcare Provider Details

I. General information

NPI: 1164882981
Provider Name (Legal Business Name): SERENITY & GRACE PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 WOODDALE BLVD STE 18
BATON ROUGE LA
70806-1570
US

IV. Provider business mailing address

1713 WOODDALE BLVD STE 18
BATON ROUGE LA
70806-1570
US

V. Phone/Fax

Practice location:
  • Phone: 225-828-1226
  • Fax:
Mailing address:
  • Phone: 225-828-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JAMES BROWN
Title or Position: OWNER
Credential:
Phone: 225-828-1226