MEDICARE: NOVICE HOUSE OF BATON ROUGE, INC.

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	251S00000X	Community/Behavioral Health Agency

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	:	1164748596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVICE HOUSE OF BATON ROUGE, INC.

Provider Business Mailing Address
First Line	:	11616 SOUTHFORK AVE STE 203
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	225-291-9718
Fax Number	:	225-291-9692

Provider Business Practice Location Address
First Line	:	11616 SOUTHFORK AVE STE 203
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	225-291-9718
Fax Number	:	225-291-9692

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ANTOINETTE M CLARK
Credential	:
Telephone Number	:	225-923-1044

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/21/2016

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Directions to “NOVICE HOUSE OF BATON ROUGE, INC. ” Practice Location

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