Provider Demographics
NPI:1134360290
Name:ACADIA LABORATORY LLC
Entity type:Organization
Organization Name:ACADIA LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-0961
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0852
Mailing Address - Country:US
Mailing Address - Phone:337-783-0961
Mailing Address - Fax:337-783-0954
Practice Address - Street 1:715 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3881
Practice Address - Country:US
Practice Address - Phone:337-783-0961
Practice Address - Fax:337-783-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42312291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00059OtherBLUE CROSS BLUE SHIELD
LA1131563Medicaid
LA1131563Medicaid