Organization Name: | DAVID RAINES COMMUNITY HEALTH CENTER, INC |
NPI Number: | 1215933254 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIE C WHITE (CEO) |
Mailing Address: | 3041 Dr Martin Luther King Dr Shreveport |
State: | LA US |
Postal Code: | 711074705 |
Phone Number: | 3182273350 |
Fax Number: | 3182222979 |
NPI Enumeration Date: | 06/23/2005 |
NPI Last Update Date: | 03/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |