Healthcare Provider Details

I. General information

NPI: 1093874000
Provider Name (Legal Business Name): ST GABRIEL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 MONTICELLO DR
SAINT GABRIEL LA
70776-4412
US

IV. Provider business mailing address

PO BOX 209
SAINT GABRIEL LA
70776-0209
US

V. Phone/Fax

Practice location:
  • Phone: 225-642-9676
  • Fax: 225-642-9696
Mailing address:
  • Phone: 225-642-9676
  • Fax: 225-642-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHLEY T. LEVY
Title or Position: CEO
Credential:
Phone: 225-642-9676