Healthcare Provider Details

I. General information

NPI: 1508291444
Provider Name (Legal Business Name): ST JOHN ASSOCIATION FOR RETARDED CITIZENS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BAMBOO RD
LA PLACE LA
70068-6457
US

IV. Provider business mailing address

101 BAMBOO RD
LA PLACE LA
70068-6457
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8003
  • Fax:
Mailing address:
  • Phone: 985-652-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL LEWIS
Title or Position: DIRECTOR
Credential:
Phone: 985-652-8003