Organization
AUTHENTIC COMMUNITY LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIE WATSON DIBIA (EXECUTIVE DIRECTOR)
(504) 368-4535
Entity
Organization
Contact information
Practice address
1799 STUMPF BLVD, BLDG.7 SUITE 1, TERRYTOWN, LA 70056-3950
(504) 368-4535
(504) 368-4560
Mailing address
1799 STUMPF BLVD, BLDG.7 SUITE 1, TERRYTOWN, LA 70056-3950
(504) 368-4535
(504) 368-4560
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
9643
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1173410
—
LA
05
—
1567337
—
LA
05
—
1567345
—
LA
Enumeration date
02/28/2008
Last updated
02/28/2008
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