Provider Demographics
NPI:1356534788
Name:TERREBONNE COUNCIL ON AGING, INC
Entity type:Organization
Organization Name:TERREBONNE COUNCIL ON AGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:EDMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-868-8411
Mailing Address - Street 1:995 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5557
Mailing Address - Country:US
Mailing Address - Phone:985-868-8411
Mailing Address - Fax:985-868-7806
Practice Address - Street 1:995 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5557
Practice Address - Country:US
Practice Address - Phone:985-868-8411
Practice Address - Fax:985-868-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1992330Medicaid