Healthcare Provider Details

I. General information

NPI: 1194650978
Provider Name (Legal Business Name): LOUISIANA DEPARTMENT OF HEALTH/OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N 4TH ST
BATON ROUGE LA
70802-5342
US

IV. Provider business mailing address

628 N 4TH ST
BATON ROUGE LA
70802-5342
US

V. Phone/Fax

Practice location:
  • Phone: 225-342-8725
  • Fax:
Mailing address:
  • Phone: 225-342-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MALCOLM CARPENTER
Title or Position: PROGRAM MANAGER 3
Credential:
Phone: 225-342-8725