Provider Demographics
NPI:1689620908
Name:ACADIANA REGIONAL SUPPORTS & SERVICES CENTER
Entity Type:Organization
Organization Name:ACADIANA REGIONAL SUPPORTS & SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR/DD REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-824-6250
Mailing Address - Street 1:224 GREMILLION CIR
Mailing Address - Street 2:P. O. BOX 218
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-3250
Mailing Address - Country:US
Mailing Address - Phone:337-821-9301
Mailing Address - Fax:337-821-9306
Practice Address - Street 1:224 GREMILLION CIR
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-3250
Practice Address - Country:US
Practice Address - Phone:337-821-9301
Practice Address - Fax:337-821-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2326251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559539Medicaid