Provider Demographics
NPI:1457974693
Name:HIV-AIDS ALLIANCE FOR REGION TWO
Entity type:Organization
Organization Name:HIV-AIDS ALLIANCE FOR REGION TWO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-424-1743
Mailing Address - Street 1:4550 NORTH BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4013
Mailing Address - Country:US
Mailing Address - Phone:225-424-1743
Mailing Address - Fax:225-927-7367
Practice Address - Street 1:3905 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3806
Practice Address - Country:US
Practice Address - Phone:225-655-6422
Practice Address - Fax:225-927-7367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIV-AIDS ALLIANCE FOR REGION TWO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)