Healthcare Provider Details

I. General information

NPI: 1346238458
Provider Name (Legal Business Name): TECHE MANOR NURSING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 MAIN ST
ARNAUDVILLE LA
70512-5716
US

IV. Provider business mailing address

883 MAIN ST
ARNAUDVILLE LA
70512-5716
US

V. Phone/Fax

Practice location:
  • Phone: 337-754-7703
  • Fax: 337-754-7702
Mailing address:
  • Phone: 337-754-7703
  • Fax: 337-754-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number397
License Number StateLA

VIII. Authorized Official

Name: WANDA HEBERT
Title or Position: ADMINSTRATOR
Credential:
Phone: 337-754-7703