NPIMap

Organization Active NPI

Marillac Community Health Centers

Doing business as DePaul Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Harvey, LA
National Provider Identifier
1720512247
Registry record updated Mar 21, 2023
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 Center
Practice address
1629 Westbank Expy
Harvey, LA 70058-4363
Phone
(504) 367-8777
Fax
(504) 367-0133
NPI assigned
Apr 12, 2017
Last updated
Mar 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Authorized official

Name
Tanyelle Oatis-Gaskew
Title
Lead Credentialing Specialist
Phone
(504) 412-9546

Specialties & licenses 1

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

Addresses

Primary practice location

1629 Westbank Expy
Harvey, LA 70058-4363

Mailing address

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

Other names 1

  • DePaul Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

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
O20170523002396 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678755535 Practice locations: Harvey, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720512247. Details of each certification follow.

Federally qualified health center certification: CCN 191966

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
May 3, 2017
Last certification
May 3, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2010 in LA
Enrollment address
1629 Westbank Expy
Ste a
Harvey, LA 70058-4364

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory
Tax ID family
Marillac Comm HLTH Centers70 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

Ownership & related parties

All disclosed owners & managing parties 5

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 DirectorBoard Member Mar 13, 2023
Roderic Teamer Individual Corporate OfficerBoard Chair Mar 13, 2023
Stephanie Navarre Individual Corporate OfficerVice Chair Mar 13, 2023
Michael Griffin Individual 5% Or Greater Direct Ownership Interest Jul 15, 2010
W-2 Managing Employee Apr 1, 2008
Robert Angelico Individual Corporate OfficerBoard Member Mar 13, 2023

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 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1720512247",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 WESTBANK EXPY",
            "city": "HARVEY",
            "state": "LA",
            "postal_code": "700584363",
            "telephone_number": "504-367-8777",
            "fax_number": "504-367-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-12",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "OATIS-GASKEW",
        "authorized_official_first_name": "TANYELLE",
        "authorized_official_title_or_position": "LEAD CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "504-412-9546"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DePaul Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harvey, LA

Sources for this page

Verify at the official NPI Registry.