Provider Demographics
NPI:1114058039
Name:AVOYELLES SOCIETY FOR THE DEVELOPMENTALLY DISABLED,INC.
Entity Type:Organization
Organization Name:AVOYELLES SOCIETY FOR THE DEVELOPMENTALLY DISABLED,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST.ADMINISTRATER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAGRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-253-5420
Mailing Address - Street 1:377 MOREAU ST
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2959
Mailing Address - Country:US
Mailing Address - Phone:318-253-5420
Mailing Address - Fax:318-240-8373
Practice Address - Street 1:377 MOREAU ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2959
Practice Address - Country:US
Practice Address - Phone:318-253-5420
Practice Address - Fax:318-240-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC7205251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929867Medicaid