Provider Demographics
NPI:1649914763
Name:TECHE ACTION BOARD, INC.
Entity type:Organization
Organization Name:TECHE ACTION BOARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVILEGING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-828-2550
Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-355-2333
Practice Address - Street 1:22187 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-3621
Practice Address - Country:US
Practice Address - Phone:225-258-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TECHE ACTION BOARD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-25
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)