Healthcare Provider Details

I. General information

NPI: 1184099574
Provider Name (Legal Business Name): INNIS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 LA HIGHWAY 78
LIVONIA LA
70755
US

IV. Provider business mailing address

6450 LOUISIANA HIGHWAY 1
BATCHELOR LA
70715
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CINDY PEAVY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 225-492-3775