Provider Demographics
NPI:1568502995
Name:ST. JOHN ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:ST. JOHN ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BABIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:985-652-8003
Mailing Address - Street 1:101 BAMBOO RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6457
Mailing Address - Country:US
Mailing Address - Phone:985-652-8003
Mailing Address - Fax:985-652-2536
Practice Address - Street 1:101 BAMBOO ROAD
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-652-8003
Practice Address - Fax:985-652-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 4824251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1692476Medicaid