MEDICARE: LA EXCEL CARE 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1205228335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA EXCEL CARE INC

Provider Business Mailing Address
First Line	:	4348 S JEFFREY DR STE 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4196
Country	:	US
Telephone Number	:	225-361-0219
Fax Number	:	225-361-0483

Provider Business Practice Location Address
First Line	:	4338 S JEFFREY DR # 102
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4196
Country	:	US
Telephone Number	:	225-361-0219
Fax Number	:	225-361-0483

Authorized Official
Title or Position	:	OWNET
Name	:	DICKSON E IDUSUYI JR.
Credential	:
Telephone Number	:	225-361-0219

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	06/29/2023

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Directions to “LA EXCEL CARE INC ” Practice Location

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