Basic Information
| Provider Information | |||||||||
| NPI: | 1275580151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACADIAN HOMECARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 51266 | ||||||||
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| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705051266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372331307 | ||||||||
| FaxNumber: | 3372335764 | ||||||||
| Practice Location | |||||||||
| Address1: | 458 HEYMANN BLVD | ||||||||
| Address2: | BLDG A | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372358185 | ||||||||
| FaxNumber: | 3372357903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | STELLY | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3372331307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1001 | LA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 190030685Z | 01 | LA | BLUE CROSS BLUE SHIELD OF | OTHER | 1400602 | 05 | LA | MEDICAID |