Provider Demographics
NPI:1770075434
Name:ACADIA TOTAL HEALTH LLC
Entity type:Organization
Organization Name:ACADIA TOTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDETERO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:337-210-4045
Mailing Address - Street 1:1307 CROWLEY RAYNE HWY STE E
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-8210
Mailing Address - Country:US
Mailing Address - Phone:337-210-4045
Mailing Address - Fax:337-210-4047
Practice Address - Street 1:1307 CROWLEY RAYNE HWY STE E
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526
Practice Address - Country:US
Practice Address - Phone:337-210-4045
Practice Address - Fax:337-210-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA112572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty