Healthcare Provider Details

I. General information

NPI: 1659437259
Provider Name (Legal Business Name): LE CONNEXION COMMUNAUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 HIGHWAY 42
PORT VINCENT LA
70726
US

IV. Provider business mailing address

PO BOX 396
FRENCH SETTLEMENT LA
70733-0396
US

V. Phone/Fax

Practice location:
  • Phone: 225-698-9008
  • Fax: 225-698-9845
Mailing address:
  • Phone: 225-698-9008
  • Fax: 225-698-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number12500
License Number StateLA

VIII. Authorized Official

Name: MS. DIANA K DARBONNE
Title or Position: BOOKKEEPER
Credential:
Phone: 225-698-9008