1689620908 NPI number — ACADIANA REGIONAL SUPPORTS & SERVICES CENTER

Table of content: (NPI 1689620908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689620908 NPI number — ACADIANA REGIONAL SUPPORTS & SERVICES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADIANA REGIONAL SUPPORTS & SERVICES CENTER
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:
Provider Other Organization Name Type Code:
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:
1689620908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 GREMILLION CIR
Provider Second Line Business Mailing Address:
P. O. BOX 218
Provider Business Mailing Address City Name:
IOTA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70543-3250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-821-9301
Provider Business Mailing Address Fax Number:
337-821-9306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 GREMILLION CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOTA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70543-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-821-9301
Provider Business Practice Location Address Fax Number:
337-821-9306
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDANIEL
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MR/DD REGIONAL ADMINISTRATOR
Authorized Official Telephone Number:
337-824-6250

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  2326 , 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: 1559539 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com