Provider Demographics
NPI:1578951547
Name:ACADIA COUNCIL ON AGING INC
Entity Type:Organization
Organization Name:ACADIA COUNCIL ON AGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:MALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-788-1400
Mailing Address - Street 1:824 E 1ST ST
Mailing Address - Street 2:PO BOX 1482
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5302
Mailing Address - Country:US
Mailing Address - Phone:337-788-1400
Mailing Address - Fax:337-788-3198
Practice Address - Street 1:824 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5302
Practice Address - Country:US
Practice Address - Phone:337-788-1400
Practice Address - Fax:337-788-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006035212343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1909319Medicaid