Provider Demographics
NPI:1750409876
Name:ASSOCIATION OF RETARDED CITIZENS OF EVANGELINE, INC
Entity type:Organization
Organization Name:ASSOCIATION OF RETARDED CITIZENS OF EVANGELINE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-5553
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0677
Mailing Address - Country:US
Mailing Address - Phone:337-363-5553
Mailing Address - Fax:337-363-5974
Practice Address - Street 1:109 WEST LASALLE STREET
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586
Practice Address - Country:US
Practice Address - Phone:337-363-5553
Practice Address - Fax:337-363-5974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATION OF RETARDED CITIZENS OF EVANGELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 2490251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1535702Medicaid