Provider Demographics
NPI:1639637671
Name:ARC OF DESOTO
Entity Type:Organization
Organization Name:ARC OF DESOTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-872-3255
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-0230
Mailing Address - Country:US
Mailing Address - Phone:318-872-3255
Mailing Address - Fax:318-872-3233
Practice Address - Street 1:1528 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-3427
Practice Address - Country:US
Practice Address - Phone:318-872-3255
Practice Address - Fax:318-872-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3188723255OtherTELEPHONE NUMBER