Healthcare Provider Details

I. General information

NPI: 1700070752
Provider Name (Legal Business Name): AIM HOME OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8923 BLUEBONNET BLVD
BATON ROUGE LA
70810
US

IV. Provider business mailing address

8923 BLUEBONNET BLVD
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4810
  • Fax: 225-769-8875
Mailing address:
  • Phone: 225-769-4810
  • Fax: 225-769-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD10659R
License Number StateLA

VIII. Authorized Official

Name: MR. PATRICK T MITCHELL
Title or Position: MANAGING MEMBER
Credential:
Phone: 225-769-2449