Healthcare Provider Details

I. General information

NPI: 1053248872
Provider Name (Legal Business Name): A DIVINE REFRESHING ADULT DAYCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 HIGHWAY 1
RACELAND LA
70394-3141
US

IV. Provider business mailing address

1719 HIMALAYA AVE
THIBODAUX LA
70301-5309
US

V. Phone/Fax

Practice location:
  • Phone: 985-837-7674
  • Fax:
Mailing address:
  • Phone: 985-837-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WYDRICKA LOFTON
Title or Position: OWNER
Credential:
Phone: 985-837-7674