Provider Demographics
NPI:1356650709
Name:A-1 CUSTOMIZED COMPANION SERVICES INC.
Entity Type:Organization
Organization Name:A-1 CUSTOMIZED COMPANION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-913-5452
Mailing Address - Street 1:2100 BELLE CHASE HWY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-6651
Mailing Address - Country:US
Mailing Address - Phone:504-361-5330
Mailing Address - Fax:504-367-6601
Practice Address - Street 1:2100 BELLE CHASE HWY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6651
Practice Address - Country:US
Practice Address - Phone:504-361-5330
Practice Address - Fax:504-367-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024Medicaid