Provider Demographics
NPI:1063411296
Name:CALCASIEU ASSOCIATION FOR RETARDED CITIZENS
Entity type:Organization
Organization Name:CALCASIEU ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:337-433-3620
Mailing Address - Street 1:4100 SN J BENNETT JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-5166
Mailing Address - Country:US
Mailing Address - Phone:337-433-0398
Mailing Address - Fax:337-489-1886
Practice Address - Street 1:4100 SN J BENNETT JOHNSTON AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-5166
Practice Address - Country:US
Practice Address - Phone:337-433-0398
Practice Address - Fax:337-489-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2466251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460061Medicaid
LA1715476Medicaid
LA1931551Medicaid
LA1715662Medicaid
LA1715816Medicaid
LA1716219Medicaid
LA1913588Medicaid
LA1915866Medicaid
LA1955957Medicaid
LA1955965Medicaid
LA1435171Medicaid
LA1666289Medicaid
LA1715824Medicaid
LA1716065Medicaid
LA1815866Medicaid