Provider Demographics
NPI:1023459559
Name:ACADIANA RECOVERY AND REHAB CENTER
Entity type:Organization
Organization Name:ACADIANA RECOVERY AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT PROGRAMS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, LAC
Authorized Official - Phone:337-236-3937
Mailing Address - Street 1:401 W VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6729
Mailing Address - Country:US
Mailing Address - Phone:337-236-5446
Mailing Address - Fax:337-524-1419
Practice Address - Street 1:401 W VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6729
Practice Address - Country:US
Practice Address - Phone:337-236-5446
Practice Address - Fax:337-524-1419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE PARISH SHERIFF'S OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781589251S00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALBHPMedicaid