MEDICARE: RED RIVER ASSOCIATION FOR RETARDED CITIZENS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	ADC2321	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215067137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED RIVER ASSOCIATION FOR RETARDED CITIZENS INC

Provider Business Mailing Address
First Line	:	2303 E CARROLL ST
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019
Country	:	US
Telephone Number	:	318-932-6520
Fax Number	:	318-932-6520

Provider Business Practice Location Address
First Line	:	1908 HWY 71 SOUTH
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019
Country	:	US
Telephone Number	:	318-932-6520
Fax Number	:	318-932-6520

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. BETTY H SULLIVAN
Credential	:
Telephone Number	:	318-932-6520

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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