Provider Demographics
NPI:1225210891
Name:ACTIVITIES OF DAILY LIVING SERVICES INC
Entity type:Organization
Organization Name:ACTIVITIES OF DAILY LIVING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-332-1810
Mailing Address - Street 1:400 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517
Mailing Address - Country:US
Mailing Address - Phone:337-332-1810
Mailing Address - Fax:337-332-3300
Practice Address - Street 1:400 RICHARD ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517
Practice Address - Country:US
Practice Address - Phone:337-332-1810
Practice Address - Fax:337-332-3300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVITIES OF DAILY LIVING SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720721Medicaid