Provider Demographics
NPI:1093937328
Name:THE ARC OF EAST ASCENSION
Entity Type:Organization
Organization Name:THE ARC OF EAST ASCENSION
Other - Org Name:COMMUNITY OPPORTUNITES OF E. ASCENSION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LABICHE
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:225-621-2000
Mailing Address - Street 1:1122 S.E. COMPLEX BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-621-2000
Mailing Address - Fax:225-621-2022
Practice Address - Street 1:1122 S.E. COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-621-2000
Practice Address - Fax:225-621-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1919110Medicaid