Provider Demographics
NPI:1902358336
Name:CHILDREN'S INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:CHILDREN'S INTERNATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-646-1580
Mailing Address - Street 1:59101 AMBER ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3708
Mailing Address - Country:US
Mailing Address - Phone:985-646-1580
Mailing Address - Fax:985-646-1579
Practice Address - Street 1:3016 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-9393
Practice Address - Country:US
Practice Address - Phone:601-732-2382
Practice Address - Fax:601-732-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015381Medicaid