Healthcare Provider Details

I. General information

NPI: 1265732960
Provider Name (Legal Business Name): CLASSIC CARE OF BATON ROUGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 SIBLEY RD SUITE A
MINDEN LA
71055-5100
US

IV. Provider business mailing address

PO BOX 6588
METAIRIE LA
70009-6588
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-1801
  • Fax: 318-371-1810
Mailing address:
  • Phone: 504-837-5557
  • Fax: 504-833-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPCA 15368
License Number StateLA

VIII. Authorized Official

Name: LARRY BUTLER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 504-837-5557