Provider Demographics
NPI:1205858388
Name:INNIS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:INNIS COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-492-3775
Mailing Address - Street 1:6450 LOUISIANA HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:BATCHELOR
Mailing Address - State:LA
Mailing Address - Zip Code:70715-6450
Mailing Address - Country:US
Mailing Address - Phone:225-492-3775
Mailing Address - Fax:225-492-3782
Practice Address - Street 1:6450 LOUISIANA HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BATCHELOR
Practice Address - State:LA
Practice Address - Zip Code:70715-6450
Practice Address - Country:US
Practice Address - Phone:225-492-3775
Practice Address - Fax:225-492-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441961Medicaid
LA191832Medicare PIN