Healthcare Provider Details

I. General information

NPI: 1437228913
Provider Name (Legal Business Name): ACADIANA PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S COLLEGE RD STE 125
LAFAYETTE LA
70503-3391
US

IV. Provider business mailing address

515 S COLLEGE RD STE 125
LAFAYETTE LA
70503-3391
US

V. Phone/Fax

Practice location:
  • Phone: 337-291-2897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number11189
License Number StateLA

VIII. Authorized Official

Name: JANELL STEPHENS
Title or Position: OWNER
Credential:
Phone: 337-291-2897