Healthcare Provider Details

I. General information

NPI: 1568502995
Provider Name (Legal Business Name): ST. JOHN ASSOCIATION FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BAMBOO ROAD
LAPLACE LA
70068
US

IV. Provider business mailing address

101 BAMBOO RD
LA PLACE LA
70068-6457
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-8003
  • Fax: 985-652-2536
Mailing address:
  • Phone: 985-652-8003
  • Fax: 985-652-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPCA 4824
License Number StateLA

VIII. Authorized Official

Name: KEITH JAMES BABIN
Title or Position: EXECUTIVE DIRECTOR
Credential: B.S.
Phone: 985-652-8003