Provider Demographics
NPI:1821287202
Name:INNIS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:INNIS COMMUNITY HEALTH CENTER, INC
Other - Org Name:POINTE COUPEE CENTRAL HIGH SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-492-3775
Mailing Address - Street 1:6450 LOUISIANA HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:BATCHELOR
Mailing Address - State:LA
Mailing Address - Zip Code:70715-0889
Mailing Address - Country:US
Mailing Address - Phone:225-492-3775
Mailing Address - Fax:
Practice Address - Street 1:8366 POINTE COUPEE RD
Practice Address - Street 2:
Practice Address - City:MORGANZA
Practice Address - State:LA
Practice Address - Zip Code:70759-3320
Practice Address - Country:US
Practice Address - Phone:225-694-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1034185Medicaid