Provider Demographics
NPI:1376667089
Name:TERREBONNE ASSOCIATION FOR RETARDED CITIZENS, INC
Entity Type:Organization
Organization Name:TERREBONNE ASSOCIATION FOR RETARDED CITIZENS, INC
Other - Org Name:TARC, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-876-4465
Mailing Address - Street 1:1 MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-5547
Mailing Address - Country:US
Mailing Address - Phone:985-876-4465
Mailing Address - Fax:985-223-7387
Practice Address - Street 1:1 MCCORD RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-5547
Practice Address - Country:US
Practice Address - Phone:985-876-4465
Practice Address - Fax:985-223-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA4515251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978906Medicaid