Provider Demographics
NPI:1366946030
Name:CHILDREN'S INTERNATIONAL, LLC
Entity type:Organization
Organization Name:CHILDREN'S INTERNATIONAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:HAYS
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-646-1580
Mailing Address - Street 1:59101 AMBER ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3708
Mailing Address - Country:US
Mailing Address - Phone:985-646-1580
Mailing Address - Fax:888-863-4274
Practice Address - Street 1:1828 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2958
Practice Address - Country:US
Practice Address - Phone:985-419-2250
Practice Address - Fax:985-419-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1020303Medicaid