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NPI Code Detail

MEDICARE: RENAISSANCE HEALTHCARE LLC

MEDICARE: RENAISSANCE HEALTHCARE LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1598950370
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAISSANCE HEALTHCARE LLC
Provider Business Mailing Address
First Line : 251 FLORIDA ST
Second Line : SUITE 201
City : BATON ROUGE
State : LA
Zip : 70801-1703
Country : US
Telephone Number : 225-387-5585
Fax Number : 225-387-5584
Provider Business Practice Location Address
First Line : 3321 YOUREE DR
Second Line : SUITE 100
City : SHREVEPORT
State : LA
Zip : 71105-2123
Country : US
Telephone Number : 318-868-6033
Fax Number : 318-868-6011
Authorized Official
Title or Position : MEMBER/MANAGER
Name : MR. JAMES A JOUBERT JR.
Credential :
Telephone Number : 225-387-5585
Provider Enumeration Date : 09/13/2007
Last Update Date : 09/13/2007

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Directions to “RENAISSANCE HEALTHCARE LLC ” Practice Location

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