Provider Demographics
NPI:1639323843
Name:BAYOU REGION SUPPORTS & SERVICE CENTER
Entity Type:Organization
Organization Name:BAYOU REGION SUPPORTS & SERVICE CENTER
Other - Org Name:ARMS COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC ADMINISTRATOR MRDD2
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-449-5181
Mailing Address - Street 1:690 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3546
Mailing Address - Country:US
Mailing Address - Phone:504-449-5181
Mailing Address - Fax:504-449-5198
Practice Address - Street 1:690 E 1ST ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3546
Practice Address - Country:US
Practice Address - Phone:504-449-5181
Practice Address - Fax:504-449-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1038315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000Medicaid