MEDICARE: ACADIAN 4005 TENANT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	264	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275537136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIAN 4005 TENANT, LLC

Provider Business Mailing Address
First Line	:	4005 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3830
Country	:	US
Telephone Number	:	225-387-5934
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3830
Country	:	US
Telephone Number	:	225-387-5934
Fax Number	:	225-387-6122

Authorized Official
Title or Position	:	COO
Name	:	MR. ALEX PALEY
Credential	:
Telephone Number	:	914-390-4363

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/11/2008

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