Organization
MARILLAC COMMUNITY HEALTH CENTERS
Active
Other names
MCHC - Gould
Organization subpart
No
Provider details
NPI number
Authorized official
TANYELLE OATIS-GASKEW (LEAD CREDENTIALING SPECIALIST)
(504) 212-9546
Entity
Organization
Contact information
Practice address
407 S GOULD AVE, GOULD, AR 71643-5041
(870) 382-3080
(870) 263-4782
Mailing address
PO BOX 13038, NEW ORLEANS, LA 70185-3038
(504) 212-9546
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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