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General NPI Number Information
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NPI Number | 1962777136
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Entity Type | Organization
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Legal Business Name | ST GABRIEL HEALTH CLINIC INC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1707 GARDERE LN STE E
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City | BATON ROUGE
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State | LA
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Zip | 70820-8166
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Country | US
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Telephone | 225-930-4922
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Fax | 225-930-4926
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | SAINT GABRIEL
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State | LA
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Zip | 70776-0209
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Country | US
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Telephone | 225-642-9676
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Fax | 225-642-9696
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Authorized Official
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Title or Position | INTERIM CHIEF EXECUTIVE OFFICER
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Name | MRS. LYSSA MORRIS
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Credential | MSN
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Telephone | 225-642-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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