Organization
CHRISTUS HEALTH CENTRAL LOUISIANA
Active
Other names
Glenmora SBHC
Organization subpart
No
Provider details
NPI number
Authorized official
MONTE WILSON (CEO)
(337) 470-2100
Entity
Organization
Contact information
Practice address
1414 7TH AVENUE, GLENMORA, LA 71433
(318) 748-8974
(318) 748-8986
Mailing address
3330 MASONIC DR, ALEXANDRIA, LA 71301-3841
(318) 483-4031
(318) 483-4044
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
234
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1446955
—
LA
Enumeration date
04/03/2007
Last updated
10/19/2022
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