Beauregard Arc
Organization Active NPI Developmentally Disabled Services Day Training Agency · Deridder, LA
NPI 1366512931 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1366512931
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Developmentally Disabled Services Day Training Agency 251C00000X
- License
- ADC 2569 (LA)
- Legal business name
- BEAUREGARD ARC
- Practice address
- 1209 Shirley St
Deridder, LA 70634-3743 - Phone
- (337) 462-2513
- Fax
- (337) 462-2513
- NPI assigned
- Nov 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jackie L Hickman
- Title
- Executive Director
- Phone
- (337) 462-2513
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Beauregard Arc
Locations
1209 Shirley St
Deridder, LA 70634
Phone (337) 462-2513
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | ADC 2569 | LA | Yes |
Addresses
Primary practice location
1209 Shirley St
Deridder, LA 70634-3743
Mailing address
1209 Shirley St
Deridder, LA 70634-3743
Phone (337) 462-2513
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1963186 | Medicaid | LA | |
| 1963194 | Medicaid | LA | |
| 1963208 | Medicaid | LA |
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All providers in Deridder, LA · Developmentally Disabled Services Day Training Agency in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.