MEDICARE: THOMAS PLACE RECOVERY HOUSE

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	251C00000X	Developmentally Disabled Services Day Training Agency	11216	LA

General Provider Information

NPI Number	:	1396964482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS PLACE RECOVERY HOUSE

Provider Business Mailing Address
First Line	:	1956 DALLAS DR STE -1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1432
Country	:	US
Telephone Number	:	225-201-1955
Fax Number	:	225-201-1966

Provider Business Practice Location Address
First Line	:	1956 DALLAS DR STE -1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-1432
Country	:	US
Telephone Number	:	225-201-1955
Fax Number	:	225-201-1966

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. ALYSSA J THOMAS
Credential	:	M.ED
Telephone Number	:	225-201-1955

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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Directions to “THOMAS PLACE RECOVERY HOUSE ” Practice Location

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