1063411296 NPI number — CALCASIEU ASSOCIATION FOR RETARDED CITIZENS

Table of content: (NPI 1063411296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063411296 NPI number — CALCASIEU ASSOCIATION FOR RETARDED CITIZENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALCASIEU 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:
Provider Other Organization Name Type Code:
6
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:
1063411296
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:
4100 SN J BENNETT JOHNSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70615-5166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-433-0398
Provider Business Mailing Address Fax Number:
337-489-1886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 SN J BENNETT JOHNSTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70615-5166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-433-0398
Provider Business Practice Location Address Fax Number:
337-489-1886
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STROUD
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
337-433-3620

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  2466 , 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: 1460061 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1715476 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1931551 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1715662 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1715816 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1716219 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1913588 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1915866 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1955957 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1955965 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1435171 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1666289 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1715824 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1716065 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1815866 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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