=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013357490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVENIR VENTURES, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2013
-----------------------------------------------------
Last Update Date | 06/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13702 COURSEY BLVD SUITE 1B
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70817-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-234-0215
-----------------------------------------------------
Fax | 855-844-8102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5959 S SHERWOOD FOREST BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-6038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-292-2031
-----------------------------------------------------
Fax | 225-295-9678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM F BORNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-247-1308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------