Provider Demographics
NPI:1215474275
Name:UNBOUND FAMILY SUPPORT ORGANIZATION, LLC.
Entity type:Organization
Organization Name:UNBOUND FAMILY SUPPORT ORGANIZATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-907-9692
Mailing Address - Street 1:3180 CONVENTION ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3711
Mailing Address - Country:US
Mailing Address - Phone:225-907-9692
Mailing Address - Fax:
Practice Address - Street 1:3180 CONVENTION ST
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3711
Practice Address - Country:US
Practice Address - Phone:225-907-9692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health