Provider Demographics
NPI:1083148381
Name:ARC OF ACADIANA, INC.
Entity Type:Organization
Organization Name:ARC OF ACADIANA, INC.
Other - Org Name:HANNIE GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:CORMIER
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-6813
Mailing Address - Street 1:6400 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-7836
Mailing Address - Country:US
Mailing Address - Phone:337-367-6813
Mailing Address - Fax:337-492-1010
Practice Address - Street 1:325 W BROUSSARD RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7813
Practice Address - Country:US
Practice Address - Phone:337-367-6813
Practice Address - Fax:337-492-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1718106Medicaid
LA2313061Medicaid
LA1098914Medicaid
LA1715131Medicaid
LA1718637Medicaid
LA1716391Medicaid
LA2155059Medicaid