# EPIPHANY HEALTHCARE OF HAMMOND

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Back 2 Health Walk-In Clinic, Epiphany Healthcare of Hammond
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417434606
- **Authorized official:** MR. CHRISTOPHER MOORE (CEO, EXECUTIVE DIRECTOR)
- **Authorized official phone:** (985) 209-6571

## Contact information

- **Practice address:** 11059 PHYLLISS LN, HAMMOND, LA 70401-1102
- **Practice address phone:** (985) 209-6571
- **Mailing address:** 11059 PHYLLISS LN, HAMMOND, LA 70401-1102
- **Mailing address phone:** (985) 209-6571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 2279H0200X | Home Health Registered Respiratory Therapist | — | NULL | — |
| 2279H0200X | Home Health Registered Respiratory Therapist | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 405300000X | Prevention Professional | 2203783830 | LA | — |

## Other

- **Enumeration date:** 07/20/2018
- **Last updated:** 09/24/2018