Marillac Community Health Centers

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MARILLAC COMMUNITY HEALTH CENTERS

Doing business as

DePaul Community Health Centers-Audubon Gentilly School

Practice address

4720 Painters St
New Orleans, LA 70122-5004

Phone

(504) 282-0089

Fax

(504) 282-0338

NPI assigned

Oct 8, 2019

Last updated

Nov 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Griffin

Title

President/Ceo

Phone

(504) 207-3060

Specialties & licenses 1

Addresses

Other names 1

• DePaul Community Health Centers-Audubon Gentilly School Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912549247. Details of each certification follow.

• CCN 191030 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 191030

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 22, 2020

Last certification

May 22, 2020

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 15, 2010 in LA

Enrollment address

4720 Painters St
New Orleans, LA 70122-5004

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.

All facility ownership & control disclosures 1

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

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1912549247",
    "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": "4720 PAINTERS ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701225004",
            "telephone_number": "504-282-0089",
            "fax_number": "504-282-0338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "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": "PRESIDENT/CEO",
        "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-Audubon Gentilly School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DePaul Community Health Centers-Audubon Gentilly School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Marillac Community Health Centers (L.B. Landry High School)
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• Lisa Marinello
• Benton Robert Marino, M.D.

• Federally Qualified Health Center (FQHC) in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Federally Qualified Health Center (FQHC) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.