Provider Demographics
NPI:1720512247
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:DEPAUL COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OATIS-GASKEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-412-9546
Mailing Address - Street 1:PO BOX 13038
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70185-3038
Mailing Address - Country:US
Mailing Address - Phone:504-207-3060
Mailing Address - Fax:
Practice Address - Street 1:1629 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4363
Practice Address - Country:US
Practice Address - Phone:504-367-8777
Practice Address - Fax:504-367-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)