Provider Demographics
NPI:1407856032
Name:ST. TAMMANY ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity Type:Organization
Organization Name:ST. TAMMANY ASSOCIATION FOR RETARDED CITIZENS, INC.
Other - Org Name:STARC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-0197
Mailing Address - Street 1:1541 SAINT ANN PL
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-2315
Mailing Address - Country:US
Mailing Address - Phone:985-646-0219
Mailing Address - Fax:985-641-8947
Practice Address - Street 1:1541 SAINT ANN PL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-2315
Practice Address - Country:US
Practice Address - Phone:985-646-0219
Practice Address - Fax:985-641-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3418251C00000X
LA9417251C00000X
251V00000X
LA766315P00000X
LA540315P00000X
LA649315P00000X
LA385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251V00000XAgenciesVoluntary or Charitable
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475254Medicaid
LA1913219Medicaid
LA1938114Medicaid
LA1717851Medicaid
LA1719030Medicaid
LA1915718Medicaid
LA1938122Medicaid
LA1436020Medicaid
LA1713261Medicaid
LA1913235Medicaid
LA1913227Medicaid