Provider Demographics
NPI:1285854380
Name:THE ARC OF IBERIA INC
Entity Type:Organization
Organization Name:THE ARC OF IBERIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-6813
Mailing Address - Street 1:1201 BRASHEAR AVE
Mailing Address - Street 2:SUITE 332
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1361
Mailing Address - Country:US
Mailing Address - Phone:337-367-6813
Mailing Address - Fax:
Practice Address - Street 1:3716 REDWOOD DR
Practice Address - Street 2:NEW IBERIA, LA 70560
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3379
Practice Address - Country:US
Practice Address - Phone:337-367-6813
Practice Address - Fax:337-367-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL 6694320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1529486Medicaid