1396219101 NPI number — ARC OF ACADIANA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396219101 NPI number — ARC OF ACADIANA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARC OF ACADIANA, 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:
1396219101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 HIGHWAY 90 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW IBERIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70560-7836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-367-6813
Provider Business Mailing Address Fax Number:
337-367-8301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 EAST B NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYNE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-367-6813
Provider Business Practice Location Address Fax Number:
337-367-8301
Provider Enumeration Date:
01/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
STUTES
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
LEE BOOK
Authorized Official Title or Position:
DIRECTOR RESDIENTIAL SERVICES
Authorized Official Telephone Number:
337-367-6813

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1718106 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2155059 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1715131 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1724971 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1718637 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2313061 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1098914 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1716391 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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