Healthcare Provider Details

I. General information

NPI: 1477796381
Provider Name (Legal Business Name): ACADIANA SUPPORTS & SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREMILLION CIRCLE
IOTA LA
70543
US

IV. Provider business mailing address

PO BOX 218
IOTA LA
70543-0218
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-6250
  • Fax: 337-821-9306
Mailing address:
  • Phone: 337-824-6250
  • Fax: 337-821-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL K MCDANIEL
Title or Position: MR DD REGIONAL ADMINISTRATOR
Credential:
Phone: 337-824-6250