Provider Demographics
NPI:1750305223
Name:SCC OF HOUMA LLC
Entity Type:Organization
Organization Name:SCC OF HOUMA LLC
Other - Org Name:CHATEAU TERREBONNE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER MEMBER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRODHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:985-872-4553
Mailing Address - Street 1:1386 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-872-4553
Mailing Address - Fax:985-872-4553
Practice Address - Street 1:1386 WEST TUNNELL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-872-4553
Practice Address - Fax:985-872-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1518069Medicaid
LA195602Medicare Oscar/Certification