Healthcare Provider Details

I. General information

NPI: 1326166323
Provider Name (Legal Business Name): THEOPHILUS COMMUNITY PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 TOM DR
BATON ROUGE LA
70815-8057
US

IV. Provider business mailing address

PO BOX 2900
GRETNA LA
70054-2900
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-1730
  • Fax: 225-928-1824
Mailing address:
  • Phone: 225-928-1730
  • Fax: 225-928-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number12186
License Number StateLA

VIII. Authorized Official

Name: MRS. SHEILA MORRIS BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, GSW
Phone: 225-928-1730