Provider Demographics
NPI:1407172125
Name:GOODWILL INDUSTRIES OF ACADIANA, INC.
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF ACADIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SUPPORTED EMPLOYMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-765-7650
Mailing Address - Street 1:1225 KALISTE SALOOM RD
Mailing Address - Street 2:P.O. BOX 62270
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5707
Mailing Address - Country:US
Mailing Address - Phone:337-765-7650
Mailing Address - Fax:337-765-7659
Practice Address - Street 1:1225 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5707
Practice Address - Country:US
Practice Address - Phone:337-765-7650
Practice Address - Fax:337-765-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC8178251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2343084Medicaid