Provider Demographics
NPI:1174495949
Name:EDWIN DRIVE GROUP HOME
Entity type:Organization
Organization Name:EDWIN DRIVE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:LEE BOOK
Authorized Official - Last Name:STUTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-367-6813
Mailing Address - Street 1:6400 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-7836
Mailing Address - Country:US
Mailing Address - Phone:337-367-6813
Mailing Address - Fax:
Practice Address - Street 1:1505 EDWIN ST
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-6603
Practice Address - Country:US
Practice Address - Phone:337-367-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARC OF ACADIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities