Provider Demographics
NPI:1679888358
Name:THE ARC OF EAST ASCENSION
Entity type:Organization
Organization Name:THE ARC OF EAST ASCENSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-621-2012
Mailing Address - Street 1:1122 E ASCENSION COMPLEX BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4265
Mailing Address - Country:US
Mailing Address - Phone:225-621-2003
Mailing Address - Fax:225-621-2022
Practice Address - Street 1:1122 E ASCENSION COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4265
Practice Address - Country:US
Practice Address - Phone:225-621-2003
Practice Address - Fax:225-621-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADHC 5057261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1083934756Medicaid
LA1639391964Medicaid
LA1093937328Medicaid
LA1902028236Medicaid
LA1265654594Medicaid
LA1982721247Medicaid
LA1356563688Medicaid
LA1285856518Medicaid