Healthcare Provider Details

I. General information

NPI: 1225630726
Provider Name (Legal Business Name): GRACE HOUSE OF BATON ROUGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 AIRLINE HWY STE 105
BATON ROUGE LA
70816-8000
US

IV. Provider business mailing address

PO BOX 485
BAKER LA
70704-0485
US

V. Phone/Fax

Practice location:
  • Phone: 225-993-0486
  • Fax:
Mailing address:
  • Phone: 225-955-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: EBONY BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 225-993-0486