Healthcare Provider Details

I. General information

NPI: 1902058563
Provider Name (Legal Business Name): ACADIANA HEALTH ALLIANCE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S COLLEGE RD SUITE 101
LAFAYETTE LA
70503-3038
US

IV. Provider business mailing address

PO BOX 53154
LAFAYETTE LA
70505-3154
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-9355
  • Fax: 337-235-9356
Mailing address:
  • Phone: 337-235-9355
  • Fax: 337-235-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN103303
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberRN 103303
License Number StateLA

VIII. Authorized Official

Name: MRS. JONEA KRYSTAL LYNN THIGPEN
Title or Position: VICE PRESIDENT
Credential: RN
Phone: 337-349-0099