Thibodaux PDHC, LLC

Primary specialty

Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X

License

2203782237 Issued in LA

Legal business name

THIBODAUX PDHC, LLC

Practice address

124 Sucre LN
Thibodaux, LA 70301-4214

Phone

(985) 446-1541

Fax

(985) 446-3864

NPI assigned

Nov 11, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Amanda Williamson

Title

Owner

Phone

(985) 446-1541

Specialties & licenses 1

Addresses

Other names 1

• Thibodaux Pediatric Day Health Care Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487635200000",
    "number": "1629474192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SUCRE LN",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014214",
            "telephone_number": "985-446-1541",
            "fax_number": "985-446-3864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SUCRE LN",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014214",
            "telephone_number": "985-446-1541",
            "fax_number": "985-446-3864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIBODAUX PDHC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-11",
        "last_updated": "2017-02-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-446-1541"
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "LA",
            "license": "2203782237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thibodaux Pediatric Day Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medically Fragile Infants and Children Day Care in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Medically Fragile Infants and Children Day Care in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.