Healthcare Provider Details

I. General information

NPI: 1003610171
Provider Name (Legal Business Name): CHILDREN'S INTERNATIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 HALL ST
WIGGINS MS
39577-2113
US

IV. Provider business mailing address

59101 AMBER ST
SLIDELL LA
70461-3708
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANJEL ELLIS
Title or Position: LOGISTIC OFFICER
Credential:
Phone: 985-646-1580