Provider Demographics
NPI:1912032038
Name:CHILDREN HEALTH CARE CLINIC OF ACADIANA
Entity Type:Organization
Organization Name:CHILDREN HEALTH CARE CLINIC OF ACADIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-237-3501
Mailing Address - Street 1:PO BOX 90408
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-0408
Mailing Address - Country:US
Mailing Address - Phone:337-237-3501
Mailing Address - Fax:337-233-9566
Practice Address - Street 1:850 N PIERCE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2848
Practice Address - Country:US
Practice Address - Phone:337-237-3501
Practice Address - Fax:337-233-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1151625Medicaid
LA1944131Medicaid
LA1443522Medicaid
LA1498882Medicaid
LA1939994Medicaid