Provider Demographics
NPI:1700868569
Name:ACADIA ST LANDRY GUEST HOME, INC
Entity Type:Organization
Organization Name:ACADIA ST LANDRY GUEST HOME, INC
Other - Org Name:ACADIA ST. LANDRY GUEST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-684-6316
Mailing Address - Street 1:830 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4402
Mailing Address - Country:US
Mailing Address - Phone:337-684-6316
Mailing Address - Fax:337-684-6315
Practice Address - Street 1:830 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4402
Practice Address - Country:US
Practice Address - Phone:337-684-6316
Practice Address - Fax:337-684-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA356314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1514667Medicaid
LA1566462Medicaid
LA30884OtherBLUECROSS BLUESHIELD
LA1566462Medicaid
195564Medicare Oscar/Certification