Provider Demographics
NPI:1427253046
Name:WINN ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity type:Organization
Organization Name:WINN ASSOCIATION FOR RETARDED CITIZENS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT, ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-628-7654
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-0566
Mailing Address - Country:US
Mailing Address - Phone:318-628-7654
Mailing Address - Fax:
Practice Address - Street 1:1006 S JONES ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483
Practice Address - Country:US
Practice Address - Phone:318-628-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADC 5271251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1951960Medicaid
LA1936448Medicaid