Organization
BEAUREGARD ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKIE L HICKMAN (EXECUTIVE DIRECTOR)
(337) 462-2513
Entity
Organization
Contact information
Practice address
1209 SHIRLEY ST, DERIDDER, LA 70634-3743
(337) 462-2513
(337) 462-2513
Mailing address
1209 SHIRLEY ST, DERIDDER, LA 70634-3743
(337) 462-2513
(337) 462-2513
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
ADC 2569
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1963186
—
LA
05
—
1963194
—
LA
05
—
1963208
—
LA
Enumeration date
11/09/2006
Last updated
08/22/2020
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