Organization
TARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELINDA BASS SHAFFETT (EXECUTIVE DIRECTOR)
(985) 549-0712
Entity
Organization
Contact information
Practice address
201 E CHURCH ST, HAMMOND, LA 70401-2628
(985) 549-0712
(985) 549-0743
Mailing address
201 E CHURCH ST, HAMMOND, LA 70401-2628
(985) 549-0712
(985) 549-0743
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1113425
—
LA
05
—
1435431
—
LA
05
—
1436194
—
LA
05
—
1436674
—
LA
Enumeration date
08/17/2006
Last updated
08/22/2020
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