Healthcare Provider Details

I. General information

NPI: 1427153378
Provider Name (Legal Business Name): LOUISIANA CNI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12804 PECOS AVE
GREENWELL SPRINGS LA
70739-3047
US

IV. Provider business mailing address

12009 FLORIDA BLVD
BATON ROUGE LA
70815-2702
US

V. Phone/Fax

Practice location:
  • Phone: 225-261-7790
  • Fax: 225-273-4305
Mailing address:
  • Phone: 225-272-2090
  • Fax: 225-273-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number886
License Number StateLA

VIII. Authorized Official

Name: TONI RIZZO
Title or Position: GENERAL MANAGER
Credential:
Phone: 225-272-2090