Provider Demographics
NPI:1710612700
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:DEPAUL COMMUNITY HEALTH CENTERS- OUR LADY OF ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR GENERALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-212-9548
Mailing Address - Street 1:3201 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4307
Mailing Address - Country:US
Mailing Address - Phone:504-212-9548
Mailing Address - Fax:
Practice Address - Street 1:5501 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2934
Practice Address - Country:US
Practice Address - Phone:504-212-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)