Provider Demographics
NPI:1013037431
Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Entity Type:Organization
Organization Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Other - Org Name:POLLOCK SBHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-470-2100
Mailing Address - Street 1:3330 MASONIC DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3841
Mailing Address - Country:US
Mailing Address - Phone:318-483-4031
Mailing Address - Fax:318-483-4044
Practice Address - Street 1:4001 HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:LA
Practice Address - Zip Code:71467-3580
Practice Address - Country:US
Practice Address - Phone:318-765-6778
Practice Address - Fax:318-765-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446866Medicaid