Provider Demographics
NPI:1124687322
Name:THIBODEAUX REAL ESTATE CONGLOMERATE
Entity type:Organization
Organization Name:THIBODEAUX REAL ESTATE CONGLOMERATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RELOCATION SERVICE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:DECLOUET
Authorized Official - Last Name:THIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-203-3757
Mailing Address - Street 1:PO BOX 22362
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-0362
Mailing Address - Country:US
Mailing Address - Phone:612-203-3757
Mailing Address - Fax:
Practice Address - Street 1:4245 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4215
Practice Address - Country:US
Practice Address - Phone:612-203-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging