Healthcare Provider Details

I. General information

NPI: 1104170992
Provider Name (Legal Business Name): ACADIAN OAKS NURSING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 01/26/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 KALISTE SALOOM RD
LAFAYETTE LA
70508-7139
US

IV. Provider business mailing address

2707 KALISTE SALOOM RD
LAFAYETTE LA
70508-7139
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2258
  • Fax:
Mailing address:
  • Phone: 337-981-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM J MCPHERSON
Title or Position: PARTNER
Credential:
Phone: 318-729-5696