Provider Demographics
NPI:1740575802
Name:ARC OF ACADIANA
Entity Type:Organization
Organization Name:ARC OF ACADIANA
Other - Org Name:THE ARC OF ACADIANA, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-6813
Mailing Address - Street 1:224 GREMILLION CIRCLE
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-0218
Mailing Address - Country:US
Mailing Address - Phone:337-367-6813
Mailing Address - Fax:337-492-1010
Practice Address - Street 1:224 GREMILLION CIRCLE
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-0218
Practice Address - Country:US
Practice Address - Phone:337-367-6813
Practice Address - Fax:337-492-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ARC OF ACADIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9910320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities