Healthcare Provider Details

I. General information

NPI: 1457974693
Provider Name (Legal Business Name): HIV-AIDS ALLIANCE FOR REGION TWO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 CONVENTION ST
BATON ROUGE LA
70806-3806
US

IV. Provider business mailing address

4550 NORTH BLVD STE 250
BATON ROUGE LA
70806-4013
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-927-7367
Mailing address:
  • Phone: 225-424-1743
  • Fax: 225-927-7367

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: SUZANNE LEBLANC
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 225-424-1743