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Southeast Community Health Systems

Organization Active NPI Federally Qualified Health Center (FQHC) · Kentwood, LA

NPI 1013468909 · NPPES record last updated Oct 17, 2016

Key facts

NPI
1013468909
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Practice address
603 9TH St
Kentwood, LA 70444-2317
Phone
(985) 514-2085
NPI assigned
Oct 17, 2016
Organization subpart
No

Authorized official

Name
Dr. Alecia Cyprian, PHD
Title
Ceo
Phone
(225) 306-2010

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Federally qualified health center certification: CCN 711035

Legal name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Doing business as
SOUTHEAST COMMUNITY HEALTH SYSTEMS - KENTWOOD HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2025
Last certification
Jan 29, 2025
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Enrollment address
603 9TH St
Kentwood, LA 70444-2317

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terry Addison
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Mira L Robertson
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Rochell Bates
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Major Coleman
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Margaret Smith
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Michael Martin
Individual 		Corporate Officer
Board Vice Chair		 Sep 1, 2016
Alecia Cyprian
Individual 		W-2 Managing Employee
Ad;		 Sep 1, 2016
Virginia Reeves Foster
Individual 		W-2 Managing Employee
Credentialing Specialist		 Sep 1, 2016
Paula McNabb
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Reyna E Lopez
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Sandy K Tillery
Individual 		Corporate Officer
Board Member		 Sep 1, 2016
Dameon Jackson
Individual 		Corporate Officer
Board Chair		 Sep 1, 2016

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kentwood
Kentwood, LA · CCN 191841		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
Albany
Hammond, LA · CCN 191895		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
Independence
Independence, LA · CCN 191918		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
WMG
Hammond, LA · CCN 191965		 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2008

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250206000244 LA Part a Provider - Federally Qualified Health Center (FQHC) 4284610437 Practice locations: Kentwood, LA

National Provider Directory

Tax ID family
SE Community Health Systems (37 organizations share this tax ID)

Locations

603 9th St
Kentwood, LA 70444
Phone (985) 514-2085

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

603 9TH St
Kentwood, LA 70444-2317

Mailing address

PO Box 770
Zachary, LA 70791-0770
Phone (225) 306-2000

Other providers in Kentwood, LA

All providers in Kentwood, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.