Healthcare Provider Details

I. General information

NPI: 1265554232
Provider Name (Legal Business Name): HIJRAH SERVICES AND ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 WOODDALE BLVD
BATON ROUGE LA
70806-1516
US

IV. Provider business mailing address

2055 WOODDALE BLVD
BATON ROUGE LA
70806-1516
US

V. Phone/Fax

Practice location:
  • Phone: 225-810-9622
  • Fax: 225-927-2464
Mailing address:
  • Phone: 225-810-9622
  • Fax: 225-927-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number14262
License Number StateLA

VIII. Authorized Official

Name: MS. KENIA RICHARDSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 225-810-9622