Provider Demographics
NPI:1497173967
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:DAUGHTERS OF CHARITY HEALTH CENTER-GENTILLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-212-9502
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:504-207-3060
Mailing Address - Fax:504-483-6018
Practice Address - Street 1:100 WARRINGTON DR.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-282-0089
Practice Address - Fax:504-282-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty