# MAISON DEVILLE OF HOUMA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215396999
- **Authorized official:** TANYA HEBERT (ASSISTANT ADMINISTRATOR)
- **Authorized official phone:** (985) 876-3250

## Contact information

- **Practice address:** 107 S HOLLYWOOD RD, HOUMA, LA 70360-2714
- **Practice address phone:** (985) 876-3250
- **Practice address fax:** (985) 873-0046
- **Mailing address:** 107 S HOLLYWOOD RD, HOUMA, LA 70360-2714
- **Mailing address phone:** (985) 876-3250
- **Mailing address fax:** (985) 873-0046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 1518425 | LA | Yes |

## Other

- **Enumeration date:** 02/23/2016
- **Last updated:** 02/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1518425 | — | LA |