Healthcare Provider Details

I. General information

NPI: 1770402356
Provider Name (Legal Business Name): INNIS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S LABAUVE AVE
BRUSLY LA
70719-2478
US

IV. Provider business mailing address

112 TELLY ST
NEW ROADS LA
70760-2521
US

V. Phone/Fax

Practice location:
  • Phone: 225-618-5015
  • Fax: 225-442-3107
Mailing address:
  • Phone: 225-618-7100
  • Fax: 225-442-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RACHEL G NELSON
Title or Position: CAO
Credential:
Phone: 225-618-7100