NPI | 1396267068 |
---|---|
Entity Type | Organization |
Authorized Contact | DEANO THORNTON CEO 318-209-4510 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
1041C0700X Social Worker Clinical | |
Enumeration Date | 2017-07-13 |
Last Update Date | 2019-06-26 |