Organization
MMO JENNINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L MILLER (CEO)
(225) 293-6774
Entity
Organization
Contact information
Practice address
728 NORTH BOULEVARD, BATON ROUGE, LA 70802-5724
(225) 293-6774
(225) 291-9229
Mailing address
619 N MAIN ST, JENNINGS, LA 70546-5347
(337) 824-4300
(337) 824-4315
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
7858
LA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1428400
—
LA
01
—
60041
BLUE CROSS
—
Enumeration date
11/04/2005
Last updated
01/11/2011
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