Healthcare Provider Details

I. General information

NPI: 1891549846
Provider Name (Legal Business Name): LIVINGSTON COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 18TH ST
MERCED CA
95340-5062
US

IV. Provider business mailing address

600 B ST
LIVINGSTON CA
95334-9593
US

V. Phone/Fax

Practice location:
  • Phone: 209-850-3500
  • Fax: 209-850-3499
Mailing address:
  • Phone: 209-850-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ABASTA-CUMMINGS
Title or Position: CEO
Credential:
Phone: 209-850-3542