Healthcare Provider Details

I. General information

NPI: 1841329729
Provider Name (Legal Business Name): ACADIAN DIABETES SELF MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ADDIE DR
CROWLEY LA
70526-7211
US

IV. Provider business mailing address

PO BOX 1254
BROUSSARD LA
70518-1254
US

V. Phone/Fax

Practice location:
  • Phone: 337-384-5611
  • Fax: 337-234-5670
Mailing address:
  • Phone: 337-234-5656
  • Fax: 337-234-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRN085391
License Number StateLA

VIII. Authorized Official

Name: MRS. TANYA F BELLER
Title or Position: OWNER RN
Credential: RN
Phone: 337-384-5611