Healthcare Provider Details

I. General information

NPI: 1346975349
Provider Name (Legal Business Name): MARILLAC COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70122-4225
US

IV. Provider business mailing address

PO BOX 13038
NEW ORLEANS LA
70185-3038
US

V. Phone/Fax

Practice location:
  • Phone: 504-513-4400
  • Fax:
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 State

VIII. Authorized Official

Name: WENDY C RIOS-WOOD
Title or Position: CREDENTIALING
Credential:
Phone: 504-207-3059