Healthcare Provider Details

I. General information

NPI: 1801286836
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GOODLETTE RD N
NAPLES FL
34102-6230
US

IV. Provider business mailing address

121 GOODLETTE RD N
NAPLES FL
34102-6230
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-6600
  • Fax:
Mailing address:
  • Phone: 239-261-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberME30891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LESLIE LASCHEID
Title or Position: CEO
Credential:
Phone: 239-529-2246