Provider Demographics
NPI:1548444037
Name:AAC MEDICAL STAFF
Entity type:Organization
Organization Name:AAC MEDICAL STAFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-233-1111
Mailing Address - Street 1:3008 W PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3417
Mailing Address - Country:US
Mailing Address - Phone:337-233-1111
Mailing Address - Fax:337-235-8888
Practice Address - Street 1:3008 W PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3417
Practice Address - Country:US
Practice Address - Phone:337-233-1111
Practice Address - Fax:337-235-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIANA ADDICTION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital