MEDICARE: BAKER COMMUNITY MENTAL HEALTH CENTER,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	014945	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003802745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER COMMUNITY MENTAL HEALTH CENTER,LLC

Provider Business Mailing Address
First Line	:	PO BOX 668
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70704-0668
Country	:	US
Telephone Number	:	225-771-1510
Fax Number	:	225-771-1520

Provider Business Practice Location Address
First Line	:	2402 MAIN ST
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-2322
Country	:	US
Telephone Number	:	225-771-1510
Fax Number	:	225-771-1520

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JESSICA L COWART
Credential	:
Telephone Number	:	225-771-1510

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	12/08/2008

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