Provider Demographics
NPI:1558487389
Name:LIVINGSTON ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:LIVINGSTON ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:LIVINGSTON ACTIVITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-664-7384
Mailing Address - Street 1:10494 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7502
Mailing Address - Country:US
Mailing Address - Phone:225-664-7384
Mailing Address - Fax:225-664-7397
Practice Address - Street 1:10494 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7502
Practice Address - Country:US
Practice Address - Phone:225-664-7384
Practice Address - Fax:225-664-7397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 2323251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1937819Medicaid