Provider Demographics
NPI:1235257676
Name:ASSOCIATION FOR RETARDED CITIZENS OF EVANGELINE, INC
Entity Type:Organization
Organization Name:ASSOCIATION FOR RETARDED CITIZENS OF EVANGELINE, INC
Other - Org Name:WEST LINCOLN ROAD COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-5553
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0677
Mailing Address - Country:US
Mailing Address - Phone:337-363-5553
Mailing Address - Fax:337-363-5974
Practice Address - Street 1:108 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-3712
Practice Address - Country:US
Practice Address - Phone:337-363-5553
Practice Address - Fax:337-363-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA582313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1718351Medicaid