Provider Demographics
NPI:1215168455
Name:AMORPHISIS INSTITUTE, NONPROFIT
Entity type:Organization
Organization Name:AMORPHISIS INSTITUTE, NONPROFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ORPHE
Authorized Official - Last Name:FUSILIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-359-7069
Mailing Address - Street 1:400 EVERETTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2630
Mailing Address - Country:US
Mailing Address - Phone:337-359-7069
Mailing Address - Fax:337-369-6557
Practice Address - Street 1:502 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4342
Practice Address - Country:US
Practice Address - Phone:337-359-7069
Practice Address - Fax:337-369-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based