Healthcare Provider Details

I. General information

NPI: 1649655440
Provider Name (Legal Business Name): CENTRAL OUTREACH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 FLORIDA BLVD STE 601
BATON ROUGE LA
70806-4287
US

IV. Provider business mailing address

5700 FLORIDA BLVD STE 601
BATON ROUGE LA
70806-4287
US

V. Phone/Fax

Practice location:
  • Phone: 225-281-0790
  • Fax: 225-281-0790
Mailing address:
  • Phone: 225-281-0790
  • Fax: 225-281-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DARLENE REESE
Title or Position: MANAGER
Credential:
Phone: 225-776-2538