NPIMap

Organization Active NPI

Innis Community Health Center, Inc

Doing business as Brusly School Based Health

  • Federally Qualified Health Center (FQHC)
  • Brusly, LA
National Provider Identifier
1013496561
Registry record updated Sep 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INNIS COMMUNITY HEALTH CENTER, INC
Doing business as
Brusly School Based Health
Brusly School Based Health Center
Practice address
630 N Vaughan Dr
Brusly, LA 70719-2217
Phone
(225) 344-0008
Fax
(225) 343-0626
NPI assigned
Aug 7, 2018
Last updated
Sep 28, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
INNIS COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cindy Griffin Peavy
Title
Ceo
Phone
(225) 618-5015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Student Health Clinic/Center 261QS1000X NU

Addresses

Primary practice location

630 N Vaughan Dr
Brusly, LA 70719-2217

Mailing address

112 Telly St
New Roads, LA 70760-2521
Phone (225) 618-5015

Other identifiers 1

IdentifierTypeStateIssuer
2480782MedicaidLA

Other names 3

  • Brusly School Based Health Doing business as
  • Brusly School Based Health Center Doing business as
  • Arbor Family Health Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180919000362 LA Part A Provider - Federally Qualified Health Center (FQHC) 9931130358 Practice locations: Brusly, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013496561. Details of each certification follow.

Federally qualified health center certification: CCN 191004

Legal name
INNIS COMMUNITY HEALTH CENTER, INC
Doing business as
BRUSLY SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 13, 2018
Last certification
Sep 13, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1999 in LA
Enrollment address
630 North Vaughn Drive
Brusly, LA 70719-2217

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Livonia Comm Health Ctr13 organizations share this tax ID, including this one
Part of
Livonia Comm Health Ctr

Other organizations with this tax ID 12

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

Locations

6450 LA Highway 1
Ste B
Batchelor, LA 70715
Phone (225) 618-5015

630 N Vaughan Dr
Brusly, LA 70719
Phone (225) 344-0008

Ownership & related parties

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
Marilu Corona Individual Corporate OfficerBoard Member Apr 19, 2019
Dania Tolliver Individual Corporate OfficerBoard Member Nov 1, 2021
Jennifer Lacour Individual Corporate DirectorBoard Member Sep 1, 2018
Beulah Epps Individual Corporate DirectorBoard Member Sep 1, 2018
Irma Smith Individual Corporate DirectorBoard Member Sep 1, 2018
Gary Scronce Individual Corporate OfficerBoard Member Nov 1, 2021
Cindy G Peavy Individual W-2 Managing EmployeeCeo Jun 1, 2013
Frances Sagona Individual Corporate OfficerBoard Member Nov 1, 2021
Rachel Nelson Individual W-2 Managing EmployeeChief Operations Officer Oct 1, 2002
Chad Olinde Individual Corporate DirectorBoard Member Sep 1, 2018
Mary Wells Individual Corporate DirectorBoard Member Jan 1, 2024
Jordan Frey Individual Corporate DirectorBoard Member Oct 1, 2023

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790553600000",
    "number": "1013496561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 TELLY ST",
            "city": "NEW ROADS",
            "state": "LA",
            "postal_code": "707602521",
            "telephone_number": "225-618-5015",
            "fax_number": "225-442-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N VAUGHAN DR",
            "city": "BRUSLY",
            "state": "LA",
            "postal_code": "707192217",
            "telephone_number": "225-344-0008",
            "fax_number": "225-343-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNIS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNIS COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2018-08-07",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A",
        "authorized_official_last_name": "PEAVY",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "GRIFFIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-618-5015"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2480782",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brusly School Based Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brusly School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Arbor Family Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brusly, LA

Sources for this page

Verify at the official NPI Registry.