Provider Demographics
NPI:1528181773
Name:ST TAMMANY ASSOC FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:ST TAMMANY ASSOC FOR RETARDED CITIZENS
Other - Org Name:STARC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-646-0219
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1436020Medicaid