Provider Demographics
NPI:1073082780
Name:CENTER FOR PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CENTER FOR PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-417-3728
Mailing Address - Street 1:PO BOX 1756
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70054-1756
Mailing Address - Country:US
Mailing Address - Phone:504-435-1444
Mailing Address - Fax:504-372-2775
Practice Address - Street 1:252 HECTOR AVE STE A
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2548
Practice Address - Country:US
Practice Address - Phone:504-417-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAMERIOtherAMERIHEALTH CARITAS LOUISIANA
LAAETNAOtherAETNA BETTER HEALTH OF LOUISIANA
LALHCOtherLA. HEALTHCARE CONNECTIONS
LAHUMOtherHUMANA
LAHUMANOtherHUMANA
LAUHCOtherUNITED HEALTHCARE COMMUNITY PLAN
LAMCAIDMedicaid
LAHBOtherHEALTHY BLUE