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NPI Code Detail

MEDICARE: LA RED HEALTH CENTER INC

MEDICARE: LA RED HEALTH CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700832185
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA RED HEALTH CENTER INC
Provider Business Mailing Address
First Line : 21444 CARMEAN WAY
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-4572
Country : US
Telephone Number : 302-855-1233
Fax Number : 302-855-2025
Provider Business Practice Location Address
First Line : 21444 CARMEAN WAY
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-4572
Country : US
Telephone Number : 302-855-1233
Fax Number : 302-855-1020
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. BRIAN SCOTT OLSON
Credential : MBA
Telephone Number : 302-855-2020
Provider Enumeration Date : 05/26/2006
Last Update Date : 09/19/2016

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Directions to “LA RED HEALTH CENTER INC ” Practice Location

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