Healthcare Provider Details

I. General information

NPI: 1215168455
Provider Name (Legal Business Name): AMORPHISIS INSTITUTE, NONPROFIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 ROBERTSON ST
NEW IBERIA LA
70560-4342
US

IV. Provider business mailing address

400 EVERETTE ST
NEW IBERIA LA
70563-2630
US

V. Phone/Fax

Practice location:
  • Phone: 337-359-7069
  • Fax: 337-369-6557
Mailing address:
  • Phone: 337-359-7069
  • Fax: 337-369-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA ORPHE FUSILIER
Title or Position: PRESIDENT
Credential:
Phone: 337-359-7069