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General NPI Number Information
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NPI Number | 1265732960
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Entity Type | Organization
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Legal Business Name | CLASSIC CARE OF BATON ROUGE, INC.
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 1321 SIBLEY RD SUITE A
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City | MINDEN
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State | LA
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Zip | 71055-5100
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Country | US
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Telephone | 318-371-1801
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Fax | 318-371-1810
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Provider Business Mailing Address
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Address Line | PO BOX 6588
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City | METAIRIE
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State | LA
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Zip | 70009-6588
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Country | US
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Telephone | 504-837-5557
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Fax | 504-833-3466
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LARRY BUTLER
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Credential |
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Telephone | 504-837-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PCA 15368
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License Number State | LA
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