MEDICARE: BEYOND INTENSIVE OUTPATIENT PROGRAM, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1053029678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND INTENSIVE OUTPATIENT PROGRAM, LLC

Provider Business Mailing Address
First Line	:	8040 STONESHIRE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-5762
Country	:	US
Telephone Number	:	225-223-0365
Fax Number	:

Provider Business Practice Location Address
First Line	:	7485 OAKLEAF DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70812-3728
Country	:	US
Telephone Number	:	225-223-0365
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHEMEELA GAIL HOWARD
Credential	:	REGISTERED NURSE
Telephone Number	:	225-930-5056

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	03/20/2025

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