Upgrade Group Home LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

UPGRADE GROUP HOME LLC

Practice address

3719 Katherine Ave
3719 Katherine Ave
Baton Rouge, LA 70805

Phone

(225) 394-9271

NPI assigned

Nov 13, 2019

Last updated

Nov 13, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carl WilliamsNPI 1245699883

Title

Dr of Theology

Phone

(225) 394-9271

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Upgrade Group Home LLC Former legal business name
• Upgrade Group Home, LLC Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl M Williams

  • Pastoral Counselor
  • Baton Rouge, LA
  • NPI 1245699883
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1306481445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 KATHERINE AVE",
            "address_2": "3719 KATHERINE AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70805",
            "telephone_number": "225-394-9271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 KATHERINE AVE",
            "address_2": "3719 KATHERINE AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70805",
            "telephone_number": "225-394-9271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPGRADE GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "DR OF THEOLOGY",
        "authorized_official_telephone_number": "225-394-9271",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8017464",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upgrade Group Home LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Upgrade Group Home, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.