Healthcare Provider Details

I. General information

NPI: 1013190180
Provider Name (Legal Business Name): ABIDE FAMILY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 BELLE TERRE BLVD STE B
LA PLACE LA
70068-1715
US

IV. Provider business mailing address

554 BELLE TERRE BLVD STE B
LA PLACE LA
70068-1715
US

V. Phone/Fax

Practice location:
  • Phone: 985-359-2527
  • Fax: 985-359-4102
Mailing address:
  • Phone: 985-359-2527
  • Fax: 985-359-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number14012
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number14012
License Number StateLA

VIII. Authorized Official

Name: LISA A CRINEL
Title or Position: CEO
Credential:
Phone: 985-359-2527