| NPI | 1639691223 |
|---|---|
| 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 | 1041C0700X Social Worker Clinical |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2019-06-26 |