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Organization

ACADIANA LONG TERM CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GEOFFREY A MIRE MD (CEO)
(337) 232-1802
Entity
Organization

Contact information

Practice address
202 WESTGATE RD, LAFAYETTE, LA 70506-2711
(337) 232-1802
(337) 232-1809
Mailing address
202 WESTGATE RD, LAFAYETTE, LA 70506-2711
(337) 232-1802
(337) 232-1809

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
025427
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1576140
LA
Enumeration date
06/16/2016
Last updated
06/16/2016
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