Provider Demographics
NPI:1841329729
Name:ACADIAN DIABETES SELF MANAGEMENT LLC
Entity type:Organization
Organization Name:ACADIAN DIABETES SELF MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-384-5611
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-1254
Mailing Address - Country:US
Mailing Address - Phone:337-234-5656
Mailing Address - Fax:337-234-5670
Practice Address - Street 1:111 ADDIE DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-7211
Practice Address - Country:US
Practice Address - Phone:337-384-5611
Practice Address - Fax:337-234-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN085391302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization