Healthcare Provider Details

I. General information

NPI: 1013496561
Provider Name (Legal Business Name): INNIS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N VAUGHAN DR
BRUSLY LA
70719-2217
US

IV. Provider business mailing address

6450 LA HIGHWAY 1 STE B
BATCHELOR LA
70715-3212
US

V. Phone/Fax

Practice location:
  • Phone: 225-385-2668
  • Fax: 225-343-0626
Mailing address:
  • Phone: 225-618-5015
  • Fax: 225-442-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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