MEDICARE: MAISON TECHE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	464	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922051796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAISON TECHE, LLC

Provider Business Mailing Address
First Line	:	2230 S MACARTHUR DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3057
Country	:	US
Telephone Number	:	318-445-4346
Fax Number	:	318-473-4360

Provider Business Practice Location Address
First Line	:	7307 E OLD SPANISH TRL
Second Line	:
City	:	JEANERETTE
State	:	LA
Zip	:	70544-6100
Country	:	US
Telephone Number	:	337-276-4514
Fax Number	:	318-473-4360

Authorized Official
Title or Position	:	MANAGER
Name	:	BRENDA TARVER
Credential	:
Telephone Number	:	318-445-4346

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/20/2008

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Directions to “MAISON TECHE, LLC ” Practice Location

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