NPIMap

Organization Active NPI

Marillac Community Health Centers

Doing business as L.B. Landry High School

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
National Provider Identifier
1942902317
Registry record updated Mar 30, 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
L.B. Landry High School
Practice address
1200 L B Landry Ave
New Orleans, LA 70114-2657
Phone
(504) 302-7170
NPI assigned
Mar 20, 2023
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 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) 212-9546

Specialties & licenses 1

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

Addresses

Primary practice location

1200 L B Landry Ave
New Orleans, LA 70114-2657

Mailing address

3201 S Carrollton Ave FL 3
New Orleans, LA 70118-4307
Phone (504) 212-9546

Other names 1

  • L.B. Landry High School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250124001840 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678755535 Practice locations: New Orleans, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942902317. Details of each certification follow.

Federally qualified health center certification: CCN 711018

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
1200 L B Landry Ave
New Orleans, LA 70114-2657

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 13

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

View all 13

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 OtherBoard Member 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

NPI Registry JSON

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1942902317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 S CARROLLTON AVE FL 3",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701184307",
            "telephone_number": "504-212-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 L B LANDRY AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701142657",
            "telephone_number": "504-302-7170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "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": "504-212-9546"
    },
    "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": "L.B. Landry High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.