Provider Demographics
NPI:1821214321
Name:DONALDSONVILLE AARC INC
Entity Type:Organization
Organization Name:DONALDSONVILLE AARC INC
Other - Org Name:MARY MARCOMBE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:BENOIT
Authorized Official - Last Name:DOMINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-473-4517
Mailing Address - Street 1:1030 CLAY ST
Mailing Address - Street 2:PO BOX 624
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-3518
Mailing Address - Country:US
Mailing Address - Phone:225-473-4517
Mailing Address - Fax:225-473-4517
Practice Address - Street 1:1030 CLAY ST
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-3518
Practice Address - Country:US
Practice Address - Phone:225-473-4517
Practice Address - Fax:225-473-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA6675385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1507440Medicaid