Healthcare Provider Details

I. General information

NPI: 1730632795
Provider Name (Legal Business Name): MARILLAC COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N TONTI ST
NEW ORLEANS LA
70119-2540
US

IV. Provider business mailing address

PO BOX 13038
NEW ORLEANS LA
70185-3038
US

V. Phone/Fax

Practice location:
  • Phone: 504-207-3060
  • Fax: 504-483-6016
Mailing address:
  • Phone: 504-207-3059
  • Fax: 504-212-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRIFFIN
Title or Position: CEO-PRESIDENT
Credential:
Phone: 504-307-1188