Provider Demographics
NPI:1992775449
Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Entity type:Organization
Organization Name:CHRISTUS HEALTH CENTRAL LOUISIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-470-2100
Mailing Address - Street 1:PO BOX 847329
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7329
Mailing Address - Country:US
Mailing Address - Phone:800-756-7999
Mailing Address - Fax:469-282-1791
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:318-487-1122
Practice Address - Fax:469-282-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720208Medicaid
LA61020OtherLA BCBS
LA=========OtherCHAMPUS
LA1720208Medicaid
LA1720208Medicaid