Provider Demographics
NPI:1699251983
Name:THE ARC OF OUACHITA
Entity type:Organization
Organization Name:THE ARC OF OUACHITA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROMA
Authorized Official - Middle Name:L W
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-387-7817
Mailing Address - Street 1:P.O. BOX 1462
Mailing Address - Street 2:901 NORTH 4TH STREET
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210
Mailing Address - Country:US
Mailing Address - Phone:318-387-7817
Mailing Address - Fax:318-322-0914
Practice Address - Street 1:901 NORTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-387-7817
Practice Address - Fax:318-322-0914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ARC OF OUACHITA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAHCBS2477364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4501626Medicaid