1295878007 NPI number — THE ARC OF OUACHITA

Table of content: (NPI 1295878007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295878007 NPI number — THE ARC OF OUACHITA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF OUACHITA
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:
1295878007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1462
Provider Second Line Business Mailing Address:
901 NORTH 4TH STREET
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-387-7817
Provider Business Mailing Address Fax Number:
318-322-0914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 MERCEDES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-5153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-387-7817
Provider Business Practice Location Address Fax Number:
318-322-0914
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
LORI
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
LOGISTICS DIRECTOR
Authorized Official Telephone Number:
318-387-7817

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  ADC 2258 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: HCBS2477 , 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: 1960641 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4501626 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com