| Grace House Of Baton Rouge, Inc. | |
|
9800 Airline Hwy Ste 105 Baton Rouge LA 70816-8000 | |
| (225) 993-0486 | |
| Not Available |
| Full Name | Grace House Of Baton Rouge, Inc. |
|---|---|
| Speciality | Assisted Living Facility |
| Location | 9800 Airline Hwy Ste 105, Baton Rouge, Louisiana |
| Authorized Official Name and Position | Ebony Brown (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2259930486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace House Of Baton Rouge, Inc. Po Box 485 Baker LA 70704-0485 Ph: (225) 955-1707 | Grace House Of Baton Rouge, Inc. 9800 Airline Hwy Ste 105 Baton Rouge LA 70816-8000 Ph: (225) 993-0486 |
| NPI Number | 1225630726 |
|---|---|
| Provider Enumeration Date | 11/10/2020 |
| Last Update Date | 11/26/2024 |
| Medicare PECOS PAC ID | 5991226268 |
|---|---|
| Medicare Enrollment ID | O20250304001696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225630726 | NPI | - | NPPES |
| XX00000 | Other | LA | OTHER |
| Provider Name | Justin D Dyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093211948 PECOS PAC ID: 0648528778 Enrollment ID: I20210721004049 |
| Provider Name | Marquita S Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790478089 PECOS PAC ID: 0547618548 Enrollment ID: I20231201001410 |
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