Healthcare Provider Details

I. General information

NPI: 1407679921
Provider Name (Legal Business Name): COMPLETE CARE OF ST GABRIEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 HIGHWAY 30 BLDG 1
SAINT GABRIEL LA
70776-5015
US

IV. Provider business mailing address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 601-665-4162
  • Fax: 855-830-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN C DUKE
Title or Position: COO
Credential:
Phone: 601-665-4162