Provider Demographics
NPI:1043565823
Name:CLHG-OAKDALE, LLC
Entity Type:Organization
Organization Name:CLHG-OAKDALE, LLC
Other - Org Name:OAKDALE FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FATULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-215-3223
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-0629
Mailing Address - Country:US
Mailing Address - Phone:318-335-3700
Mailing Address - Fax:
Practice Address - Street 1:400 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2628
Practice Address - Country:US
Practice Address - Phone:318-335-3501
Practice Address - Fax:318-485-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208M00000X
LA629282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty