Provider Demographics
NPI:1831594241
Name:MARILLAC COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:MARILLAC COMMUNITY HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-212-9502
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 1:3715 WILLIAMS BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-468-4437
Practice Address - Fax:504-471-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty