Healthcare Provider Details

I. General information

NPI: 1558581017
Provider Name (Legal Business Name): CALCASIEU ASSOCIATIN FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROYAL ST
LAKE CHARLES LA
70607-6338
US

IV. Provider business mailing address

4100 J. BENNETT JOHNSTON AVE.
LAKE CHARLES LA
70615-3445
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-3620
  • Fax: 337-439-1886
Mailing address:
  • Phone: 337-433-3620
  • Fax: 337-439-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number305
License Number StateLA

VIII. Authorized Official

Name: MS. LORETTA O. LAFLEUR
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 337-433-3620