Healthcare Provider Details

I. General information

NPI: 1043125693
Provider Name (Legal Business Name): MARILLAC COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S CARROLLTON AVE
NEW ORLEANS LA
70118-4307
US

IV. Provider business mailing address

5035 IBERVILLE STREET
ST GABRIEL LA
70776
US

V. Phone/Fax

Practice location:
  • Phone: 504-207-3060
  • Fax: 504-483-6016
Mailing address:
  • Phone: 504-207-3060
  • Fax: 504-483-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL

VIII. Authorized Official

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