Provider Demographics
NPI:1578684494
Name:ACADIA PARISH POLICE JURY COMMUNITY CLINIC
Entity Type:Organization
Organization Name:ACADIA PARISH POLICE JURY COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.,DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:RAVEY
Authorized Official - Last Name:SIGNORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-334-2153
Mailing Address - Street 1:200 FROG FESTIVAL DR
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-4733
Mailing Address - Country:US
Mailing Address - Phone:337-334-2153
Mailing Address - Fax:337-334-2192
Practice Address - Street 1:200 FROG FESTIVAL DR
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-4733
Practice Address - Country:US
Practice Address - Phone:337-334-2153
Practice Address - Fax:337-334-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1410705Medicaid