Marillac Community Health Centers
Organization Active NPI Federally Qualified Health Center (FQHC) · New Orleans, LA
NPI 1457701575 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1457701575
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MARILLAC COMMUNITY HEALTH CENTERS
- Practice address
- 1300 Oretha Castle Haley Blvd
Suite B
New Orleans, LA 70113-1001 - Phone
- (504) 899-5437
- Fax
- (504) 899-8668
- NPI assigned
- Jun 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Tanyelle Oatis-Gaskew
- Title
- Lead Credentialing Specialist
- Phone
- (504) 482-4080
Other NPIs on the same Medicare enrollment 21
Corporate family (same tax ID) 24
Practitioners 5
-
Clair Nicole Brown, APRN
-
Iliana Cabrera, APRN-CNP
-
Tashika Edward, FNP
-
Danielle Dupont Ragsdale, NP-C
-
Paige Angele Roberts, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Federally qualified health center certification: CCN 191183
- 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
- Mar 22, 2024
- Last certification
- Mar 22, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 14, 2010 in LA
- Enrollment address
- 1300 Oretha Castle Haley Blvd
Suite B
New Orleans, LA 70113-1001
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Ellen Kron |
Corporate Director |
Oct 26, 2010 | |
| Michael Deyoung |
Corporate Director |
Oct 26, 2010 | |
| Roderic Teamer |
Corporate Director |
Oct 26, 2010 | |
| Ronald Carrere |
Corporate Director |
Dec 18, 2023 | |
| Sarah Moody-Thomas |
Corporate Director |
Dec 18, 2023 | |
| Flori Hicks |
Corporate Director |
Dec 18, 2023 | |
| Stephanie Navarre |
Corporate Director |
Oct 26, 2010 | |
| Marjorie Hebert |
Corporate Director | Oct 26, 2010 | |
| Catherine Kelly |
Corporate Director |
Oct 26, 2010 | |
| Anna Garner |
Corporate Director |
Oct 26, 2010 | |
| Michael Griffin |
W-2 Managing Employee |
Jul 27, 2001 | |
| Robert Angelico |
Corporate Director |
Oct 26, 2010 | |
| Jedidah Jackson |
Corporate Director |
Oct 26, 2010 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Depaul Community Health Centers |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 15, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110314000767 | LA | Part B Supplier - Clinic/Group Practice | 3678755535 |
Receives reassigned benefits from 128 practitioners 21 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kenner, LA; New Orleans, LA; Metairie, LA; Harvey, LA |
| O20240507000181 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 3678755535 | Practice locations: New Orleans, LA |
National Provider Directory
- Tax ID family
- Marillac Comm HLTH Centers
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1300 Oretha Castle Haley Blvd
Suite B
New Orleans, LA 70113-1001
Mailing address
PO Box 13038
New Orleans, LA 70185-3038
Phone (504) 207-3060
Other names
- DePaul Community Health Center - Central City
Other providers in New Orleans, LA
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
- Marillac Community Health Centers
All providers in New Orleans, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.