Healthcare Provider Details

I. General information

NPI: 1205957347
Provider Name (Legal Business Name): ACADIANA CIRCLE OF FRIENDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 BONIN RD
YOUNGSVILLE LA
70592-5658
US

IV. Provider business mailing address

2403 BONIN RD
YOUNGSVILLE LA
70592-5658
US

V. Phone/Fax

Practice location:
  • Phone: 337-856-0460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateLA

VIII. Authorized Official

Name: SHAWN JANES
Title or Position: OWNER
Credential:
Phone: 337-856-0460