Provider Demographics
NPI:1396138145
Name:COMMUNITY HEALTHCARE CLINIC, LLC
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:D,
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:337-288-1508
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70517-0597
Mailing Address - Country:US
Mailing Address - Phone:337-434-6146
Mailing Address - Fax:337-434-6149
Practice Address - Street 1:1421 HENDERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:LA
Practice Address - Zip Code:70517
Practice Address - Country:US
Practice Address - Phone:337-434-6146
Practice Address - Fax:337-464-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04925363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1820466Medicaid
LA1820466Medicaid