Provider Demographics
NPI:1346567690
Name:TECHE SPECIALTY HOSPITAL, LLC
Entity Type:Organization
Organization Name:TECHE SPECIALTY HOSPITAL, LLC
Other - Org Name:IBERIA REHABILITATON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-364-6923
Mailing Address - Street 1:532 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4948
Mailing Address - Country:US
Mailing Address - Phone:337-364-6923
Mailing Address - Fax:337-608-0362
Practice Address - Street 1:532 JEFFERSON TER
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4948
Practice Address - Country:US
Practice Address - Phone:337-364-6923
Practice Address - Fax:337-608-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
LA283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA190304Medicare Oscar/Certification
LA193091Medicare Oscar/Certification