Provider Demographics
NPI:1801216767
Name:COMMON GROUND HEALTH CLINIC
Entity Type:Organization
Organization Name:COMMON GROUND HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKSTER-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-361-9800
Mailing Address - Street 1:441 WALL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7723
Mailing Address - Country:US
Mailing Address - Phone:504-361-9800
Mailing Address - Fax:504-368-9836
Practice Address - Street 1:3737 GENERAL DEGAULLE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8205
Practice Address - Country:US
Practice Address - Phone:504-361-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QF0400X261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2356241Medicaid