Provider Demographics
NPI:1902469653
Name:CLHG-DEQUINCY, LLC
Entity Type:Organization
Organization Name:CLHG-DEQUINCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERIED
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAIRGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-375-5997
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-1166
Mailing Address - Country:US
Mailing Address - Phone:337-786-1200
Mailing Address - Fax:337-786-1219
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3508
Practice Address - Country:US
Practice Address - Phone:337-786-1200
Practice Address - Fax:337-786-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1741795Medicaid