Healthcare Provider Details

I. General information

NPI: 1700868569
Provider Name (Legal Business Name): ACADIA ST LANDRY GUEST HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S BROADWAY ST
CHURCH POINT LA
70525-4402
US

IV. Provider business mailing address

830 S BROADWAY ST
CHURCH POINT LA
70525-4402
US

V. Phone/Fax

Practice location:
  • Phone: 337-684-6316
  • Fax: 337-684-6315
Mailing address:
  • Phone: 337-684-6316
  • Fax: 337-684-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number356
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HENSGENS
Title or Position: ADMINISTRATOR
Credential:
Phone: 337-684-6316