Provider Demographics
NPI:1841908761
Name:COLLECTIVE RURAL HEALTHCARE SYSTEM LLC
Entity type:Organization
Organization Name:COLLECTIVE RURAL HEALTHCARE SYSTEM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:JEANSONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-880-2144
Mailing Address - Street 1:912 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-4288
Mailing Address - Country:US
Mailing Address - Phone:888-995-0591
Mailing Address - Fax:318-581-9067
Practice Address - Street 1:4855 HIGHWAY 10 WEST
Practice Address - Street 2:SUITE C
Practice Address - City:ELIZABETH
Practice Address - State:LA
Practice Address - Zip Code:70638
Practice Address - Country:US
Practice Address - Phone:318-634-5600
Practice Address - Fax:318-634-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health