Provider Demographics
NPI:1104148154
Name:ACADIANA SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:ACADIANA SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SILAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-984-8875
Mailing Address - Street 1:318-A GUILBEAU ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-984-8875
Mailing Address - Fax:337-984-8879
Practice Address - Street 1:318-A GUILBEAU ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-984-8875
Practice Address - Fax:337-984-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1307521253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307521Medicaid