Provider Demographics
NPI:1134479066
Name:ARC OF ACADIANA, INC
Entity type:Organization
Organization Name:ARC OF ACADIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:CORMIER
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-6813
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2853320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155059Medicaid
LA1098914Medicaid
LA1715131Medicaid
LA1716391Medicaid
LA1718637Medicaid