Healthcare Provider Details

I. General information

NPI: 1093726978
Provider Name (Legal Business Name): STC ADDICTION WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CORA DR
BATON ROUGE LA
70815-4201
US

IV. Provider business mailing address

150 CORA DR
BATON ROUGE LA
70815-4201
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-1611
  • Fax: 225-343-5300
Mailing address:
  • Phone: 225-387-1611
  • Fax: 225-343-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number203
License Number StateLA

VIII. Authorized Official

Name: ANGELA N BADEAUX
Title or Position: FINANCIAL OFFICE MANAGER
Credential:
Phone: 225-387-1611