Healthcare Provider Details

I. General information

NPI: 1023162153
Provider Name (Legal Business Name): EVANGELINE COUNCIL ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 N REED ST
VILLE PLATTE LA
70586-2504
US

IV. Provider business mailing address

1012 N REED ST
VILLE PLATTE LA
70586-2504
US

V. Phone/Fax

Practice location:
  • Phone: 337-363-5161
  • Fax: 337-363-5301
Mailing address:
  • Phone: 337-363-5161
  • Fax: 337-363-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPCA 3677
License Number StateLA

VIII. Authorized Official

Name: MR. EUGENE J LEBOEUF
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 337-363-5161