Provider Demographics
NPI:1508312265
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:DEPAUL COMMUNITY HEALTH CENTERS-ST. MARY'S ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
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:504-207-3060
Mailing Address - Street 1:PO BOX 13038
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70185-3038
Mailing Address - Country:US
Mailing Address - Phone:504-207-3059
Mailing Address - Fax:504-212-9539
Practice Address - Street 1:6905 CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-5215
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:504-483-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty