Provider Demographics
NPI:1598000796
Name:RICHLAND ASSOCIATION FOR RETARDED CITIZENS INC
Entity Type:Organization
Organization Name:RICHLAND ASSOCIATION FOR RETARDED CITIZENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CISSIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-878-2508
Mailing Address - Street 1:119 CHARTER ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2105
Mailing Address - Country:US
Mailing Address - Phone:318-878-2508
Mailing Address - Fax:318-878-9725
Practice Address - Street 1:119 CHARTER ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2105
Practice Address - Country:US
Practice Address - Phone:318-878-2508
Practice Address - Fax:318-878-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC2238251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1957097Medicaid