Provider Demographics
NPI:1790257434
Name:CLHG-LEESVILLE
Entity Type:Organization
Organization Name:CLHG-LEESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-226-8202
Mailing Address - Street 1:1020 W FERTITTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4645
Mailing Address - Country:US
Mailing Address - Phone:318-239-9041
Mailing Address - Fax:318-239-5360
Practice Address - Street 1:427 N PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3905
Practice Address - Country:US
Practice Address - Phone:337-462-6471
Practice Address - Fax:337-462-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health