Provider Demographics
NPI:1437320751
Name:SOUTHERN INGENUITY, INC.
Entity Type:Organization
Organization Name:SOUTHERN INGENUITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-927-5068
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-0038
Mailing Address - Country:US
Mailing Address - Phone:318-927-5046
Mailing Address - Fax:318-927-5055
Practice Address - Street 1:598 HARMON LOOP
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-5830
Practice Address - Country:US
Practice Address - Phone:318-927-5046
Practice Address - Fax:318-927-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1971243Medicaid