Healthcare Provider Details

I. General information

NPI: 1861614471
Provider Name (Legal Business Name): CALCASIEU ASSOCIATION FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 19TH STREET
LAKE CHARLES LA
70601
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 Number2102830354
License Number StateLA

VIII. Authorized Official

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