Provider Demographics
NPI:1609865096
Name:ACADIAN OAKS NURSING HOME LLC
Entity Type:Organization
Organization Name:ACADIAN OAKS NURSING HOME LLC
Other - Org Name:MAISON DE LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-981-2258
Mailing Address - Street 1:2707 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7139
Mailing Address - Country:US
Mailing Address - Phone:337-981-2258
Mailing Address - Fax:337-988-3807
Practice Address - Street 1:2707 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7139
Practice Address - Country:US
Practice Address - Phone:337-981-2258
Practice Address - Fax:337-988-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA688314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1520578Medicaid
LA4772690001Medicare NSC
LA1520578Medicaid