Provider Demographics
NPI:1699185769
Name:CITY OF NEW ORLEANS HEALTH CARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:CITY OF NEW ORLEANS HEALTH CARE FOR THE HOMELESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENNESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-658-2785
Mailing Address - Street 1:2222 SIMON BOLIVAR AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1460
Mailing Address - Country:US
Mailing Address - Phone:504-658-2785
Mailing Address - Fax:
Practice Address - Street 1:2222 SIMON BOLIVAR AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1460
Practice Address - Country:US
Practice Address - Phone:504-658-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherMEDICARE FQHC