Provider Demographics
NPI:1437102969
Name:PROGRESSIVE ACUTE CARE DAUTERIVE, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ACUTE CARE DAUTERIVE, LLC
Other - Org Name:DAUTERIVE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-624-7401
Mailing Address - Street 1:600 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2043
Mailing Address - Country:US
Mailing Address - Phone:337-365-7311
Mailing Address - Fax:337-374-4104
Practice Address - Street 1:600 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2043
Practice Address - Country:US
Practice Address - Phone:337-365-7311
Practice Address - Fax:337-374-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA61026OtherBCBS-PSYCH