Provider Demographics
NPI:1437298304
Name:EVANGLEINE COUNCIL ON AGING
Entity Type:Organization
Organization Name:EVANGLEINE COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBOEUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-5161
Mailing Address - Street 1:1012 N REED ST
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-2504
Mailing Address - Country:US
Mailing Address - Phone:337-363-5161
Mailing Address - Fax:337-363-5301
Practice Address - Street 1:1012 N REED ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-2504
Practice Address - Country:US
Practice Address - Phone:337-363-5161
Practice Address - Fax:337-363-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 3677305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1179078Medicaid