Provider Demographics
NPI:1326032806
Name:FLEUR DE LIS COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:FLEUR DE LIS COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN FNP-C
Authorized Official - Phone:337-668-4141
Mailing Address - Street 1:376 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANKTON
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5920
Mailing Address - Country:US
Mailing Address - Phone:337-668-4141
Mailing Address - Fax:337-668-4386
Practice Address - Street 1:376 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANKTON
Practice Address - State:LA
Practice Address - Zip Code:70584-5920
Practice Address - Country:US
Practice Address - Phone:337-668-4141
Practice Address - Fax:337-668-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPENDING261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447919Medicaid
LA193862Medicare Oscar/Certification