Basic Information
| Provider Information | |||||||||
| NPI: | 1356886634 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S INTERNATIONAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59101 AMBER ST | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704613708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856461580 | ||||||||
| FaxNumber: | 9856461579 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 WILLIAMS AVE | ||||||||
| Address2: | |||||||||
| City: | PICAYUNE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394663956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017985558 | ||||||||
| FaxNumber: | 6017989915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2016 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | ZACHARIAH | ||||||||
| AuthorizedOfficialMiddleName: | HAYS | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF RURAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 6013372464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.