1457974693 NPI number — HIV-AIDS ALLIANCE FOR REGION TWO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457974693 NPI number — HIV-AIDS ALLIANCE FOR REGION TWO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIV-AIDS ALLIANCE FOR REGION TWO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457974693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 NORTH BLVD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70806-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-424-1743
Provider Business Mailing Address Fax Number:
225-927-7367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3905 CONVENTION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-655-6422
Provider Business Practice Location Address Fax Number:
225-927-7367
Provider Enumeration Date:
05/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLANC
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
225-424-1743

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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