Healthcare Provider Details

I. General information

NPI: 1346567690
Provider Name (Legal Business Name): TECHE SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 JEFFERSON TER
NEW IBERIA LA
70560-4948
US

IV. Provider business mailing address

532 JEFFERSON TER
NEW IBERIA LA
70560-4948
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-6923
  • Fax: 337-608-0362
Mailing address:
  • Phone: 337-364-6923
  • Fax: 337-608-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. ATHAN J. OLIVIER III
Title or Position: CEO
Credential:
Phone: 337-364-6923