Healthcare Provider Details

I. General information

NPI: 1104969914
Provider Name (Legal Business Name): ASSOC FOR RETARDED CITIZENS OUACHITA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MERCEDES DR
MONROE LA
71201-5153
US

IV. Provider business mailing address

PO BOX 1462
MONROE LA
71210-1462
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-7817
  • Fax: 318-322-0914
Mailing address:
  • Phone: 318-387-7817
  • Fax: 318-322-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LORI DENISE GREGORY
Title or Position: LOGISTICS DIRECTOR
Credential:
Phone: 318-387-7817