Healthcare Provider Details

I. General information

NPI: 1437102969
Provider Name (Legal Business Name): PROGRESSIVE ACUTE CARE DAUTERIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N LEWIS ST
NEW IBERIA LA
70563-2043
US

IV. Provider business mailing address

600 N LEWIS ST
NEW IBERIA LA
70563-2043
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-7311
  • Fax: 337-374-4104
Mailing address:
  • Phone: 337-365-7311
  • Fax: 337-374-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: WAYNE THOMPSON
Title or Position: CFO
Credential:
Phone: 985-624-7401