Healthcare Provider Details

I. General information

NPI: 1619758034
Provider Name (Legal Business Name): RED STICK RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12025 JUSTICE AVE
BATON ROUGE LA
70816-5327
US

IV. Provider business mailing address

6720 GREENMEADOW DR
GREENWELL SPRINGS LA
70739-4102
US

V. Phone/Fax

Practice location:
  • Phone: 225-713-4050
  • Fax: 225-713-4050
Mailing address:
  • Phone: 225-771-8365
  • Fax: 225-771-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KALEY BENSON
Title or Position: CEO
Credential: RN
Phone: 225-978-4264