Provider Demographics
NPI:1306031380
Name:ABIDE FAMILY SUPPORT SERVICES
Entity Type:Organization
Organization Name:ABIDE FAMILY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRINEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-359-2527
Mailing Address - Street 1:554 BELLE TERRE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1715
Mailing Address - Country:US
Mailing Address - Phone:985-359-2527
Mailing Address - Fax:985-359-4102
Practice Address - Street 1:554 BELLE TERRE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:985-359-2527
Practice Address - Fax:985-359-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14012251C00000X
LAPCA 14012251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024473Medicaid