Provider Demographics
NPI:1609142033
Name:LOUISIANA INDUSTRIES FOR THE DISABLED, INC.
Entity Type:Organization
Organization Name:LOUISIANA INDUSTRIES FOR THE DISABLED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-928-1400
Mailing Address - Street 1:1979 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1410
Mailing Address - Country:US
Mailing Address - Phone:225-928-1400
Mailing Address - Fax:
Practice Address - Street 1:855 SAINT FERDINAND ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6453
Practice Address - Country:US
Practice Address - Phone:225-336-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAC2104251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health