Provider Demographics
NPI:1447574447
Name:BAYOU COMMUNITY HEALTH CENTER INC.
Entity Type:Organization
Organization Name:BAYOU COMMUNITY HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEVELLE
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-572-0953
Mailing Address - Street 1:11848 S HARRELL'S FERRY RD
Mailing Address - Street 2:STE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2593
Mailing Address - Country:US
Mailing Address - Phone:225-572-0953
Mailing Address - Fax:225-774-2947
Practice Address - Street 1:11848 S HARRELL'S FERRY RD
Practice Address - Street 2:SUITE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2593
Practice Address - Country:US
Practice Address - Phone:225-572-0953
Practice Address - Fax:225-774-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health