MEDICARE: CATHOLIC CHARITIES OF THE DIOCESE 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
2	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1336467877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES OF THE DIOCESE OF BATON ROUGE, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 1668
Second Line	:	1900 S. ACADIAN THRUWAY
City	:	BATON ROUGE
State	:	LA
Zip	:	70821-1668
Country	:	US
Telephone Number	:	225-336-8770
Fax Number	:	225-336-8745

Provider Business Practice Location Address
First Line	:	1900 S. ACADIAN THRUWAY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808
Country	:	US
Telephone Number	:	225-336-8708
Fax Number	:	225-336-8703

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAVID C. AGUILLARD
Credential	:
Telephone Number	:	225-336-8770

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/07/2010

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