Provider Demographics
NPI:1487914925
Name:ACADIANA YOUTH, INC.
Entity type:Organization
Organization Name:ACADIANA YOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-237-1320
Mailing Address - Street 1:911 LEE AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7959
Mailing Address - Country:US
Mailing Address - Phone:337-237-1320
Mailing Address - Fax:337-237-0806
Practice Address - Street 1:1000 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3140
Practice Address - Country:US
Practice Address - Phone:337-237-1320
Practice Address - Fax:337-237-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2332253J00000X
LA4986253J00000X
LA22037813793245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No253J00000XAgenciesFoster Care Agency