Provider Demographics
NPI:1457413635
Name:ACADIANA CONCERN FOR AIDS RELIEF EDUCATION AND SUPPORT, INC.
Entity Type:Organization
Organization Name:ACADIANA CONCERN FOR AIDS RELIEF EDUCATION AND SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-2437
Mailing Address - Street 1:PO BOX 3865
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70502-3865
Mailing Address - Country:US
Mailing Address - Phone:337-233-2437
Mailing Address - Fax:337-235-4178
Practice Address - Street 1:809 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1884
Practice Address - Country:US
Practice Address - Phone:337-233-2437
Practice Address - Fax:337-235-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM4010251B00000X
261Q00000X, 261QR0405X
LASA0008130324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1109711Medicaid
LA600749121OtherMGL MIS