Healthcare Provider Details

I. General information

NPI: 1700940244
Provider Name (Legal Business Name): CALCASIEU ASSOC FOR RETARDED CITIZENS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 J BENNETT JOHNSTON AVE
LAKE CHARLES LA
70615-5166
US

IV. Provider business mailing address

4100 J BENNETT JOHNSTON AVE
LAKE CHARLES LA
70615-5166
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 Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number3676
License Number StateLA

VIII. Authorized Official

Name: LORETTA LAFLEUR
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 337-433-3620