Healthcare Provider Details

I. General information

NPI: 1609149103
Provider Name (Legal Business Name): AB GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MAIN ST
BATON ROUGE LA
70802-4660
US

IV. Provider business mailing address

2736 FLORIDA ST
BATON ROUGE LA
70802-2719
US

V. Phone/Fax

Practice location:
  • Phone: 225-336-0349
  • Fax: 225-336-5409
Mailing address:
  • Phone: 225-383-9139
  • Fax: 225-336-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. COLLIS BENTON TEMPLE JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-383-9139