Provider Demographics
NPI:1285838904
Name:BEAUREGARD ARC
Entity Type:Organization
Organization Name:BEAUREGARD ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WYSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-462-2513
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-0013
Mailing Address - Country:US
Mailing Address - Phone:337-462-2513
Mailing Address - Fax:337-462-2513
Practice Address - Street 1:1209 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3743
Practice Address - Country:US
Practice Address - Phone:337-462-2513
Practice Address - Fax:337-462-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 2569251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1963194Medicaid
LA1963208Medicaid