Provider Demographics
NPI:1255469136
Name:ISLAND ENTERPRISES, INC.
Entity Type:Organization
Organization Name:ISLAND ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-698-1500
Mailing Address - Street 1:17321 CLINE DR
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-5128
Mailing Address - Country:US
Mailing Address - Phone:225-698-9379
Mailing Address - Fax:225-698-3651
Practice Address - Street 1:1257 N BARMAN AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2440
Practice Address - Country:US
Practice Address - Phone:225-644-6951
Practice Address - Fax:225-644-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10358251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1712841Medicaid