=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407679921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE CARE OF ST GABRIEL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 735 HIGHWAY 30 BLDG 1
-----------------------------------------------------
City | SAINT GABRIEL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70776-5015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-665-4162
-----------------------------------------------------
Fax | 855-830-3484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 KATHERINE DR STE A
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-9588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-665-4162
-----------------------------------------------------
Fax | 855-830-3484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JOHN C DUKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-665-4162
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------