Provider Demographics
NPI:1437930625
Name:MARILLAC COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTER
Other - Org Name:RESURRECTION OF OUR LORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OATIS-GASKEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-212-9546
Mailing Address - Street 1:PO BOX 4148
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70178-4148
Mailing Address - Country:US
Mailing Address - Phone:504-212-9558
Mailing Address - Fax:
Practice Address - Street 1:4861 ROSALIA DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3562
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)