Provider Demographics
NPI:1902058563
Name:ACADIANA HEALTH ALLIANCE, LLC.
Entity Type:Organization
Organization Name:ACADIANA HEALTH ALLIANCE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONEA
Authorized Official - Middle Name:KRYSTAL LYNN
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-349-0099
Mailing Address - Street 1:PO BOX 53154
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3154
Mailing Address - Country:US
Mailing Address - Phone:337-235-9355
Mailing Address - Fax:337-235-9356
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-235-9355
Practice Address - Fax:337-235-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 253Z00000X
LARN103303251J00000X
LARN 103303261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care