Healthcare Provider Details

I. General information

NPI: 1922376128
Provider Name (Legal Business Name): PROJECT VIDA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 S. KNOX
FT. HANCOCK TX
79839
US

IV. Provider business mailing address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

V. Phone/Fax

Practice location:
  • Phone: 915-769-1079
  • Fax:
Mailing address:
  • Phone: 915-533-7057
  • Fax:

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: MR. WILLIAM SCHLESINGER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 915-533-7057