Healthcare Provider Details

I. General information

NPI: 1679086888
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 10TH ST
RICHMOND IN
47374-5547
US

IV. Provider business mailing address

1100 REID PKWY
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-965-4299
  • Fax: 765-962-0030
Mailing address:
  • Phone: 765-965-4299
  • Fax: 765-962-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISTY NASH
Title or Position: DIRECTOR
Credential: CPCS
Phone: 765-983-3127