=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891045761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIV/AIDS ALLIANCE FOR REGION TWO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2012
-----------------------------------------------------
Last Update Date | 09/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4550 NORTH BLVD 250
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-927-1269
-----------------------------------------------------
Fax | 225-927-7367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4550 NORTH BLVD 250
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-927-1269
-----------------------------------------------------
Fax | 225-927-7367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. TIMOTHY YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-927-1269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | CM1000
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------