Provider Demographics
NPI:1255357638
Name:FAMILY HEALTH OF ST. HELENA, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH OF ST. HELENA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-665-5149
Mailing Address - Street 1:1810 FLORIDA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4930
Mailing Address - Country:US
Mailing Address - Phone:225-791-3092
Mailing Address - Fax:225-791-3854
Practice Address - Street 1:51991 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-3011
Practice Address - Country:US
Practice Address - Phone:225-791-3092
Practice Address - Fax:225-791-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARH0006883261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459607Medicaid
LA1459607Medicaid