Provider Demographics
NPI:1083707665
Name:STRIDES OF ACADIANA, LLC
Entity Type:Organization
Organization Name:STRIDES OF ACADIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-831-4522
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0216
Mailing Address - Country:US
Mailing Address - Phone:337-363-3750
Mailing Address - Fax:337-363-3753
Practice Address - Street 1:502 W. LASALLE ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-3750
Practice Address - Fax:337-363-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11984251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1771015Medicaid