Healthcare Provider Details

I. General information

NPI: 1043423288
Provider Name (Legal Business Name): DDMS OF LOUISIANA NO. 2, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 YMCA PLAZA DR BLDG 9
BATON ROUGE LA
70810-0927
US

IV. Provider business mailing address

313 CONGRESS ST
BOSTON MA
02210-1218
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-2344
  • Fax: 225-767-8068
Mailing address:
  • Phone: 800-388-5150
  • Fax: 617-790-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number859
License Number StateLA

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VP & SR. ASST GC
Credential:
Phone: 952-836-2234