=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891940599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NATURAL HEALTH CLINIC AND SPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2008
-----------------------------------------------------
Last Update Date | 11/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10632 STANLEY AUBIN LN APT A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-295-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10632 STANLEY AUBIN LN APT A 11924 COURSEY BLVD SUITE # B
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70816-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-295-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FLORIDA LEA BAKER
-----------------------------------------------------
Credential | PERSONAL CARE SER.
-----------------------------------------------------
Telephone | 225-926-1990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------