Healthcare Provider Details

I. General information

NPI: 1972987105
Provider Name (Legal Business Name): WINN COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 HWY 500
GEORGETOWN LA
71432
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-827-5306
  • Fax:
Mailing address:
  • Phone: 318-648-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEANO THORNTON
Title or Position: CEO
Credential:
Phone: 318-648-0375