Provider Demographics
NPI:1205827151
Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Entity Type:Organization
Organization Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Other - Org Name:CHRISTUS COUSHATTA RINGGOLD RURAL HEALTH CENTER
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:PO BOX 847329
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7329
Mailing Address - Country:US
Mailing Address - Phone:800-756-7999
Mailing Address - Fax:469-282-1791
Practice Address - Street 1:3342 BIENVILLE RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:LA
Practice Address - Zip Code:71068-3242
Practice Address - Country:US
Practice Address - Phone:318-894-9611
Practice Address - Fax:318-894-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA551RHC-2261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444651Medicaid
LA5CP64Medicare PIN
LA193447Medicare Oscar/Certification
LAC82544Medicare PIN