Provider Demographics
NPI:1275993156
Name:ACADIANA OUTREACH CENTER
Entity Type:Organization
Organization Name:ACADIANA OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE-ALYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CAC
Authorized Official - Phone:337-237-7618
Mailing Address - Street 1:PO BOX 2747
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70502
Mailing Address - Country:US
Mailing Address - Phone:337-237-7618
Mailing Address - Fax:337-237-7650
Practice Address - Street 1:625 N UNIVERSITY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70502
Practice Address - Country:US
Practice Address - Phone:337-237-7618
Practice Address - Fax:337-237-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008597939324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility