Healthcare Provider Details

I. General information

NPI: 1033032800
Provider Name (Legal Business Name): LIFE COAST COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 JEFFERSON TER STE C
NEW IBERIA LA
70560-4980
US

IV. Provider business mailing address

516 JEFFERSON TER STE C
NEW IBERIA LA
70560-4980
US

V. Phone/Fax

Practice location:
  • Phone: 985-492-6170
  • Fax:
Mailing address:
  • Phone: 337-369-0070
  • Fax: 337-369-0075

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: DIANE WEBRE
Title or Position: SPECIALIST
Credential:
Phone: 985-492-6170