Healthcare Provider Details

I. General information

NPI: 1912598418
Provider Name (Legal Business Name): CLHG-AVOYELLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 WATER ST
LECOMPTE LA
71346-4734
US

IV. Provider business mailing address

4231 LA-1192
MARKSVILLE LA
71351
US

V. Phone/Fax

Practice location:
  • Phone: 318-406-8010
  • Fax: 318-406-8011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NELL FEHMIE OLGUIN
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 318-253-0677