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Marillac Community Health Centers

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

NPI 1629329735 · NPPES record last updated Nov 22, 2022

Key facts

NPI
1629329735
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MARILLAC COMMUNITY HEALTH CENTERS
Practice address
111 N Causeway Blvd
Metairie, LA 70001-5450
Phone
(504) 482-0084
NPI assigned
Sep 28, 2012
Organization subpart
No

Authorized official

Name
Michael Griffin
Title
President/Ceo
Phone
(504) 212-9502

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 24

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

Practitioners 69

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

View all 69

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Federally qualified health center certification: CCN 191905

Legal name
MARILLAC COMMUNITY HEALTH CENTERS
Doing business as
DEPAUL COUMMUNTIY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2013
Last certification
Aug 6, 2013
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jul 14, 2010 in LA
Enrollment address
111 N Causeway Blvd
Metairie, LA 70001-5450

All disclosed owners & managing parties 8

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 		Corporate Director
Director		 Sep 15, 2020
Marie Sedgwick
Individual 		Corporate Director
Director		 Sep 15, 2020
Michael Todd
Individual 		Corporate Director
Director		 Sep 15, 2020
Roderic Teamer
Individual 		Corporate Officer
Treasurer		 Sep 15, 2020
Sam Leblanc
Individual 		Corporate Officer
Chair		 Sep 15, 2020
Therese Badon
Individual 		Corporate Officer
Vice-Chair		 Sep 15, 2020
Michael Griffin
Individual 		Corporate Officer
President/Ceo		 Sep 15, 2020
W-2 Managing Employee Sep 15, 2020
Robert Angelico
Individual 		Corporate Director
Director		 Sep 15, 2020

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 Centers
New Orleans, LA · CCN 191974		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2010

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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
O20130731000006 LA Part a Provider - Federally Qualified Health Center (FQHC) 3678755535 Practice locations: Metairie, LA

National Provider Directory

Tax ID family
Marillac Comm HLTH Centers (69 organizations share this tax ID)

Locations

531 Williams Blvd
Kenner, LA 70062

3116 6th St
Metairie, LA 70002

4400 General Meyer Ave
New Orleans, LA 70131
Phone (503) 302-7135

3600 Prytania St
Ste 100
New Orleans, LA 70115
Phone (504) 899-5434

3600 Prytania St
Ste B
New Orleans, LA 70115

100 Warrington Dr
Ste B
New Orleans, LA 70122

5630 Read Blvd
Ste B
New Orleans, LA 70127

Specialties & licenses

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

Addresses

Primary practice location

111 N Causeway Blvd
Metairie, LA 70001-5450

Mailing address

3201 S Carrollton Ave
New Orleans, LA 70118-4307

Other names

  • Daughters of Charity Health Center-Metairie Doing business as

Other providers in Metairie, LA

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

Sources for this page

Verify at the official NPI Registry.