Provider Demographics
NPI:1932473584
Name:COMMUNITY CHOICES WAIVER - LAFAYETTE
Entity Type:Organization
Organization Name:COMMUNITY CHOICES WAIVER - LAFAYETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-261-0160
Mailing Address - Street 1:3804 JOHNSTON ST
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3851
Mailing Address - Country:US
Mailing Address - Phone:337-984-3104
Mailing Address - Fax:337-984-4446
Practice Address - Street 1:3804 JOHNSTON ST
Practice Address - Street 2:BUILDING 1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3851
Practice Address - Country:US
Practice Address - Phone:337-984-3104
Practice Address - Fax:337-984-4446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CARE OPTIONS - LAFAYETTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health