Healthcare Provider Details

I. General information

NPI: 1598679953
Provider Name (Legal Business Name): LIFE COAST COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
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: 337-369-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL

VIII. Authorized Official

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