Healthcare Provider Details

I. General information

NPI: 1316610736
Provider Name (Legal Business Name): MARILLAC COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 11/22/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 6TH ST STE 101
METAIRIE LA
70002-1762
US

IV. Provider business mailing address

PO BOX 13038
NEW ORLEANS LA
70185-3038
US

V. Phone/Fax

Practice location:
  • Phone: 504-837-9000
  • Fax:
Mailing address:
  • Phone: 504-207-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRIFFIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 504-207-3060