Provider Demographics
NPI:1811366958
Name:ARC OF ACADIANA, INC
Entity Type:Organization
Organization Name:ARC OF ACADIANA, INC
Other - Org Name:ARC OF ACADIANA, NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:318-742-6220
Mailing Address - Street 1:5401 SHED RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5420
Mailing Address - Country:US
Mailing Address - Phone:318-742-6220
Mailing Address - Fax:318-741-5297
Practice Address - Street 1:5401 SHED RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5420
Practice Address - Country:US
Practice Address - Phone:318-742-6220
Practice Address - Fax:318-741-5297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARC OF ACADIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 11414320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1098914Medicaid
LA1718637Medicaid
LA1679691Medicaid
LA1934950Medicaid
LA1715131Medicaid
LA1716391Medicaid
LA2155059Medicaid
LA2313061Medicaid
LA1171972Medicaid
LA1718106Medicaid
LA1931560Medicaid
LA1934941Medicaid
LA1935239Medicaid