Organization
UPGRADE GROUP HOME LLC
Active
Other names
Upgrade Group Home, LLC, Upgrade Group Home LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL WILLIAMS (DR OF THEOLOGY)
(225) 394-9271
Entity
Organization
Contact information
Practice address
3719 KATHERINE AVE, 3719 KATHERINE AVE, BATON ROUGE, LA 70805
(225) 394-9271
Mailing address
3719 KATHERINE AVE, 3719 KATHERINE AVE, BATON ROUGE, LA 70805
(225) 394-9271
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8017464
—
LA
Enumeration date
11/13/2019
Last updated
11/13/2019
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