Provider Demographics
NPI:1790456499
Name:INNIS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:INNIS COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-492-3775
Mailing Address - Street 1:1620 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3219
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-720-1039
Practice Address - Street 1:6450 LA HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BATCHELOR
Practice Address - State:LA
Practice Address - Zip Code:70715-3212
Practice Address - Country:US
Practice Address - Phone:225-492-3775
Practice Address - Fax:225-492-3782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNIS COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy