Healthcare Provider Details

I. General information

NPI: 1790456499
Provider Name (Legal Business Name): INNIS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 LA HIGHWAY 1
BATCHELOR LA
70715-3212
US

IV. Provider business mailing address

1620 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051-3219
US

V. Phone/Fax

Practice location:
  • Phone: 225-395-1381
  • Fax:
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-720-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CINDY GRIFFIN PEAVY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 225-618-7161