MEDICARE: GENESIS OF NEW IBERIA 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	1118991	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	:	1801892716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS OF NEW IBERIA INC.

Provider Business Mailing Address
First Line	:	847 STEWART ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-8539
Country	:	US
Telephone Number	:	337-237-4673
Fax Number	:	337-237-4674

Provider Business Practice Location Address
First Line	:	224 N LEWIS ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70563-2841
Country	:	US
Telephone Number	:	337-237-4673
Fax Number	:	337-237-4674

Authorized Official
Title or Position	:	CFO
Name	:	WILL J ARLEDGE
Credential	:
Telephone Number	:	337-237-4673

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/14/2008

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