Healthcare Provider Details

I. General information

NPI: 1841342490
Provider Name (Legal Business Name): LAFOURCHE ARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MAIN ST
THIBODAUX LA
70301-5216
US

IV. Provider business mailing address

100 W MAIN ST
THIBODAUX LA
70301-5216
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-6214
  • Fax: 985-447-4813
Mailing address:
  • Phone: 985-447-6214
  • Fax: 985-447-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number388
License Number StateLA

VIII. Authorized Official

Name: RICKY BONVILLAIN
Title or Position: FISCAL SERVICES DIRECTOR
Credential:
Phone: 985-447-6214