Provider Demographics
NPI:1053021667
Name:LIFE COAST COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:LIFE COAST COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-492-6170
Mailing Address - Street 1:1101 AUDUBON AVE STE S1
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4957
Mailing Address - Country:US
Mailing Address - Phone:985-492-6170
Mailing Address - Fax:985-492-6177
Practice Address - Street 1:605 ENTERPRISE DR STE C
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5405
Practice Address - Country:US
Practice Address - Phone:985-360-3755
Practice Address - Fax:985-879-4580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE COAST COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)