MEDICARE: COGNITIVE DEVELOPMENT CENTER OF BATON ROUGE

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

General Provider Information

NPI Number	:	1245550979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNITIVE DEVELOPMENT CENTER OF BATON ROUGE

Provider Business Mailing Address
First Line	:	PO BOX 7563
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71211-7563
Country	:	US
Telephone Number	:	318-614-7644
Fax Number	:	318-340-1539

Provider Business Practice Location Address
First Line	:	7525 FLORIDA BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4703
Country	:	US
Telephone Number	:	225-926-9706
Fax Number	:	225-926-9708

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ADRIAN FISHER
Credential	:
Telephone Number	:	318-614-7644

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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