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3285 Highway 75 Saint Gabriel LA 70776-4409 | |
(225) 642-9676 | |
(225) 642-9696 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 3285 Highway 75, Saint Gabriel, Louisiana |
Authorized Official Name and Position | Shirley Freeman Wade (CEO) |
Authorized Official Contact | 2256429676 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 209 Saint Gabriel LA 70776-0209 Ph: (225) 642-3676 | 3285 Highway 75 Saint Gabriel LA 70776-4409 Ph: (225) 642-9676 |
NPI Number | 1922279843 |
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Provider Enumeration Date | 03/19/2008 |
Last Update Date | 10/26/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922279843 | NPI | - | NPPES |
1457680 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |