Provider Demographics
NPI:1770760902
Name:PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Entity type:Organization
Organization Name:PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:225-683-5292
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-389-1311
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:203 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3219
Practice Address - Country:US
Practice Address - Phone:225-389-1311
Practice Address - Fax:225-389-1330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038814Medicaid
191860Medicare PIN
LA1038814Medicaid