Healthcare Provider Details

I. General information

NPI: 1750305223
Provider Name (Legal Business Name): SCC OF HOUMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 WEST TUNNELL BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

1386 W TUNNEL BLVD
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-872-4553
  • Fax: 985-872-1803
Mailing address:
  • Phone: 985-872-4553
  • Fax: 985-872-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BOULWARE
Title or Position: MANAGER
Credential:
Phone: 972-428-0900