Provider Demographics
NPI:1083040711
Name:CRESCENT CITY HEALTH LLC
Entity Type:Organization
Organization Name:CRESCENT CITY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BURNELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-822-8262
Mailing Address - Street 1:2475 CANAL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6549
Mailing Address - Country:US
Mailing Address - Phone:504-822-8262
Mailing Address - Fax:504-822-8264
Practice Address - Street 1:2222 SIMON BOLIVAR AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1460
Practice Address - Country:US
Practice Address - Phone:504-571-1607
Practice Address - Fax:504-571-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care