Provider Demographics
NPI:1336279439
Name:THE ARC OF SABINE INC
Entity Type:Organization
Organization Name:THE ARC OF SABINE INC
Other - Org Name:PROVENZA COMMUNITY HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-256-2025
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-1150
Mailing Address - Country:US
Mailing Address - Phone:318-256-2025
Mailing Address - Fax:318-256-0143
Practice Address - Street 1:144 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-2543
Practice Address - Country:US
Practice Address - Phone:318-645-4191
Practice Address - Fax:318-256-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1717720Medicaid
LA19G469OtherDHH PROVIDER #