NPIMap

Organization Active NPI

Marillac Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
National Provider Identifier
1285199059
Registry record updated Nov 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARILLAC COMMUNITY HEALTH CENTERS
Doing business as
DePaul Community health Centers-Andrew Wilson Charter School
Practice address
3617 General Pershing St
New Orleans, LA 70125-4530
Phone
(504) 282-0089
Fax
(504) 282-0338
NPI assigned
Feb 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2022

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

Authorized official

Name
Michael Griffin
Title
Ceo/President
Phone
(504) 207-3060

Specialties & licenses 1

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

Addresses

Primary practice location

3617 General Pershing St
New Orleans, LA 70125-4530

Mailing address

PO Box 13038
New Orleans, LA 70185-3038
Phone (504) 207-3060

Other names 1

  • DePaul Community health Centers-Andrew Wilson Charter School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250123002261 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678755535 Practice locations: New Orleans, LA

Federally qualified health center certification: CCN 711012

Legal name
MARILLAC COMMUNITY HEALTH CENTERS
Doing business as
DEPAUL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 14, 2025
Last certification
Jan 14, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3617 General Pershing St
New Orleans, LA 70125-4530

National Provider Directory

National Provider Directory
Tax ID family
Marillac Comm HLTH Centers69 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1629 Westbank Expy
Harvey, LA 70058
Phone (504) 367-8777

3116 6th St
Ste 101
Metairie, LA 70002
Phone (504) 837-9000

615 City Park Ave
New Orleans, LA 70119

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ellen Kron Individual OtherBoard Member Jan 1, 2019
Wendy Rios-Wood Individual W-2 Managing EmployeeDelegated Official Jan 1, 2023
Michael Deyoung Individual Other Jan 1, 2019
Roderic Teamer Individual OtherBoard Member Jan 1, 2019
Ronald Carrere Individual OtherBoard Member Jan 1, 2019
Sarah Moody-Thomas Individual OtherBoard Member Jan 1, 2019
Flori Hicks Individual OtherBoard Member Jan 1, 2019
Stephanie Navarre Individual OtherBoard Member Jan 1, 2019
Marjorie Hebert Individual OtherBoard Member Jan 1, 2019
Catherine Kelly Individual OtherBoard Member Jan 1, 2019
Anna Garner Individual OtherBoard Member Jan 1, 2019
Michael Griffin Individual Corporate DirectorPresident-Ceo Apr 1, 2008
W-2 Managing EmployeeCeo/President Apr 1, 2008
Robert Angelico Individual OtherBoard Member Jan 1, 2019
Jedidah Jackson Individual OtherBoard Member Jan 1, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Depaul Community Health CentersNew Orleans, LA, CCN 191974 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2010

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1549411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1285199059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13038",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701853038",
            "telephone_number": "504-207-3060",
            "fax_number": "504-483-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 GENERAL PERSHING ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701254530",
            "telephone_number": "504-282-0089",
            "fax_number": "504-282-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-06",
        "last_updated": "2022-11-22",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "504-207-3060"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Community health Centers-Andrew Wilson Charter School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DePaul Community health Centers-Andrew Wilson Charter School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.