Provider Demographics
NPI:1750579611
Name:LAFAYETTE COUNCIL ON AGING, INC.
Entity type:Organization
Organization Name:LAFAYETTE COUNCIL ON AGING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECRTOR OF PROGRAMS AND PERSONNEL
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-262-5990
Mailing Address - Street 1:160 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8309
Mailing Address - Country:US
Mailing Address - Phone:337-262-5990
Mailing Address - Fax:337-262-1365
Practice Address - Street 1:160 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8309
Practice Address - Country:US
Practice Address - Phone:337-262-5990
Practice Address - Fax:337-262-1365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE COUNCIL ON AGING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 140233747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty