Healthcare Provider Details

I. General information

NPI: 1023650066
Provider Name (Legal Business Name): LIVINGSTON COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 COLORADO AVE
TURLOCK CA
95382-2011
US

IV. Provider business mailing address

600 B ST
LIVINGSTON CA
95334-9593
US

V. Phone/Fax

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