Healthcare Provider Details

I. General information

NPI: 1306962717
Provider Name (Legal Business Name): THE ARC OF IBERIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 REDWOOD DR
NEW IBERIA LA
70560-3379
US

IV. Provider business mailing address

3716 REDWOOD DR
NEW IBERIA LA
70560-3379
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-6813
  • Fax:
Mailing address:
  • Phone: 337-367-6813
  • Fax: 337-367-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number1002
License Number StateLA

VIII. Authorized Official

Name: MR. KENNY PATTON
Title or Position: EXECTIVE DIRECTOR
Credential:
Phone: 337-367-6813