Healthcare Provider Details

I. General information

NPI: 1477657658
Provider Name (Legal Business Name): ADVOCATES FOR A HEALTHY COMMUNITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 LYNN ST
LEBANON MO
65536-3832
US

IV. Provider business mailing address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

V. Phone/Fax

Practice location:
  • Phone: 417-831-0150
  • Fax:
Mailing address:
  • Phone: 417-851-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH BROOKS MILLER JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-831-0150