Provider Demographics
NPI:1013196765
Name:ST. CHARLES COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:ST. CHARLES COMMUNITY HEALTH CENTER, INC.
Other - Org Name:NORCO ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-575-3700
Mailing Address - Street 1:425 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-2137
Mailing Address - Country:US
Mailing Address - Phone:985-764-9084
Mailing Address - Fax:985-764-8464
Practice Address - Street 1:425 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:LA
Practice Address - Zip Code:70079-2137
Practice Address - Country:US
Practice Address - Phone:985-764-9084
Practice Address - Fax:985-764-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444642Medicaid
LA1444642Medicaid