Healthcare Provider Details

I. General information

NPI: 1083707665
Provider Name (Legal Business Name): STRIDES OF ACADIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W. LASALLE ST
VILLE PLATTE LA
70586
US

IV. Provider business mailing address

PO BOX 216
VILLE PLATTE LA
70586-0216
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-3750
  • Fax: 337-363-3753
Mailing address:
  • Phone: 337-363-3750
  • Fax: 337-363-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number11984
License Number StateLA

VIII. Authorized Official

Name: MR. KAYLA KINCANON
Title or Position: OWNER
Credential:
Phone: 337-831-4522