Provider Demographics
NPI:1508291444
Name:ST JOHN ASSOCIATION FOR RETARDED CITIZENS INC
Entity Type:Organization
Organization Name:ST JOHN ASSOCIATION FOR RETARDED CITIZENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-652-8003
Mailing Address - Street 1:101 BAMBOO RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6457
Mailing Address - Country:US
Mailing Address - Phone:985-652-8003
Mailing Address - Fax:
Practice Address - Street 1:101 BAMBOO RD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6457
Practice Address - Country:US
Practice Address - Phone:985-652-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1955761Medicaid
LA1955779Medicaid
LA1172031Medicaid
LA1692476Medicaid