MEDICARE: LOUISIANA DEPARTMENT OF HEALTH/OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1194650978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA DEPARTMENT OF HEALTH/OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES

Provider Business Mailing Address
First Line	:	628 N 4TH ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5342
Country	:	US
Telephone Number	:	225-342-8725
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 N 4TH ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-5342
Country	:	US
Telephone Number	:	225-342-8725
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER 3
Name	:	MALCOLM CARPENTER
Credential	:
Telephone Number	:	225-342-8725

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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