Provider Demographics
NPI:1578003265
Name:LAFOUCHE PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:LAFOUCHE PARISH SCHOOL BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAT
Authorized Official - Phone:985-859-5359
Mailing Address - Street 1:1355 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4236
Mailing Address - Country:US
Mailing Address - Phone:985-859-5359
Mailing Address - Fax:
Practice Address - Street 1:1355 TIGER DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4236
Practice Address - Country:US
Practice Address - Phone:985-859-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit