Healthcare Provider Details

I. General information

NPI: 1083350888
Provider Name (Legal Business Name): HIV-AIDS ALLIANCE FOR REGION TWO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 COLONIAL DR
BATON ROUGE LA
70806-6512
US

IV. Provider business mailing address

9516 AIRLINE HWY
BATON ROUGE LA
70815-5501
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5903
Mailing address:
  • Phone: 225-655-6422
  • Fax: 225-341-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TIM YOUNG
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 225-424-1800