Provider Demographics
NPI:1336680529
Name:CHILDREN'S INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:CHILDREN'S INTERNATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-646-1580
Mailing Address - Street 1:59101 AMBER ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3708
Mailing Address - Country:US
Mailing Address - Phone:985-646-1580
Mailing Address - Fax:985-646-1579
Practice Address - Street 1:618 BLUE MEADOW RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2834
Practice Address - Country:US
Practice Address - Phone:228-467-1320
Practice Address - Fax:228-467-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care