Healthcare Provider Details

I. General information

NPI: 1538623640
Provider Name (Legal Business Name): CLHG-LEESVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W FERTITTA BLVD
LEESVILLE LA
71446-4645
US

IV. Provider business mailing address

1020 W FERTITTA BLVD
LEESVILLE LA
71446-4645
US

V. Phone/Fax

Practice location:
  • Phone: 318-239-9041
  • Fax: 318-239-5360
Mailing address:
  • Phone: 318-239-9041
  • Fax: 318-239-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DONALD E. CAMERON
Title or Position: CEO
Credential:
Phone: 318-226-8202