Provider Demographics
NPI: | 1992870091 |
---|---|
Name: | POINTE COUPEE COMMUNITY CARE |
Entity type: | Organization |
Organization Name: | POINTE COUPEE COMMUNITY CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHARLEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROUGEAU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 318-473-0863 |
Mailing Address - Street 1: | 3700 BAYOU RAPIDES RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ALEXANDRIA |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 71303-3601 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 318-473-0863 |
Mailing Address - Fax: | 318-473-9889 |
Practice Address - Street 1: | 148B E MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | NEW ROADS |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70760-3506 |
Practice Address - Country: | US |
Practice Address - Phone: | 225-618-0202 |
Practice Address - Fax: | 225-618-0222 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-22 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | 1178390 | Medicaid |