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Organization

OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

Active
Parent organization
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Other names
Our Lady of the Lake Children's Health Developmental Center at McMains
Organization subpart
Yes

Provider details

NPI number
Legal business name
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Authorized official
JAMY RICHARD (VP OF FINANCE)
(225) 526-0121
Entity
Organization

Contact information

Practice address
1805 COLLEGE DR, BATON ROUGE, LA 70808-1919
(225) 923-3420
(225) 922-9316
Mailing address
PO BOX 677957, DALLAS, TX 75267-7957
(225) 765-5727

Taxonomy

Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary

Other

Enumeration date
08/18/2023
Last updated
08/18/2023
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