Basic Information
| Provider Information | |||||||||
| NPI: | 1053463562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISIANA EMPOWERMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1676 DALLAS DR STE C | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708061409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252925151 | ||||||||
| FaxNumber: | 2252925152 | ||||||||
| Practice Location | |||||||||
| Address1: | 1676 DALLAS DR STE C | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708061409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252925151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | RESHONDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2252925151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY EMPOWERMENT SERVICES,LLC | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301868B | 05 | NC | MEDICAID | 8301868G | 05 | NC | MEDICAID |