Healthcare Provider Details

I. General information

NPI: 1538538863
Provider Name (Legal Business Name): INNIS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77575 LANDRY DRIVE
MARINGOUIN LA
70757-3028
US

IV. Provider business mailing address

6450 LOUISIANA HIGHWAY 1
BATCHELOR LA
70715
US

V. Phone/Fax

Practice location:
  • Phone: 225-625-2105
  • Fax: 225-625-2109
Mailing address:
  • Phone: 225-492-3775
  • Fax: 225-492-3782

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 NELSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 225-492-3775