1396940433 NPI number — RICHLAND ASSOCIATION FOR RETARDED CITIZENS

Table of content: (NPI 1396940433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396940433 NPI number — RICHLAND ASSOCIATION FOR RETARDED CITIZENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHLAND ASSOCIATION FOR RETARDED CITIZENS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHLAND ARC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396940433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 CHARTER ST
Provider Second Line Business Mailing Address:
SAME
Provider Business Mailing Address City Name:
DELHI
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71232-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-878-2508
Provider Business Mailing Address Fax Number:
318-878-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 CHARTER ST
Provider Second Line Business Practice Location Address:
SAME
Provider Business Practice Location Address City Name:
DELHI
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71232-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-878-2508
Provider Business Practice Location Address Fax Number:
318-878-9725
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCORMICK
Authorized Official First Name:
CISSIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
318-878-2508

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  ADC 2238 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1957097 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1957101 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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