1417050634 NPI number — THE ARC OF ST. MARTIN, INC.

Table of content: (NPI 1417050634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417050634 NPI number — THE ARC OF ST. MARTIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF ST. MARTIN, INC.
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:
1417050634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARTINVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70582-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-394-4928
Provider Business Mailing Address Fax Number:
337-394-5974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 LELIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT MARTINVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70582-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-394-4928
Provider Business Practice Location Address Fax Number:
337-394-5974
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LATIOLAIS
Authorized Official First Name:
KERRIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
337-394-4928

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  5239 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320600000X , with the licence number: 558 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320600000X , with the licence number: 559 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X , with the licence number: 7296 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X , with the licence number: 5021 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1935182 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718025 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1985147 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467952 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718033 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932329 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1567671 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1936731 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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