Healthcare Provider Details

I. General information

NPI: 1235600990
Provider Name (Legal Business Name): TENSAS COMMUNITY HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CARTER ST STE A
VIDALIA LA
71373-3208
US

IV. Provider business mailing address

PO BOX 46
SAINT JOSEPH LA
71366-0046
US

V. Phone/Fax

Practice location:
  • Phone: 318-766-1967
  • Fax:
Mailing address:
  • Phone: 318-766-1967
  • Fax: 318-766-9090

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: DAWN C JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 318-766-1967