Healthcare Provider Details

I. General information

NPI: 1891045761
Provider Name (Legal Business Name): HIV/AIDS ALLIANCE FOR REGION TWO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 NORTH BLVD 250
BATON ROUGE LA
70806-4013
US

IV. Provider business mailing address

4550 NORTH BLVD 250
BATON ROUGE LA
70806-4013
US

V. Phone/Fax

Practice location:
  • Phone: 225-927-1269
  • Fax: 225-927-7367
Mailing address:
  • Phone: 225-927-1269
  • Fax: 225-927-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCM1000
License Number StateLA

VIII. Authorized Official

Name: MR. TIMOTHY YOUNG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 225-927-1269