Healthcare Provider Details

I. General information

NPI: 1437336195
Provider Name (Legal Business Name): ADVOCATES FOR A HEALTHY COMMUNITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 BANNING ST
MARSHFIELD MO
65706-1015
US

IV. Provider business mailing address

440 E TAMPA ST
SPRINGFIELD MO
65806-1131
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-2400
  • Fax: 417-831-0155
Mailing address:
  • Phone: 417-831-0150
  • Fax: 417-831-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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