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General NPI Number Information
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NPI Number | 1245721539
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Entity Type | Organization
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Legal Business Name | LIVINGSTON COMMUNITY HEALTH
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 600 B STREET SUITE A, B, C
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City | LIVINGSTON
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State | CA
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Zip | 95334-1257
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Country | US
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Telephone | 209-394-7913
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Fax | 209-394-9093
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Provider Business Mailing Address
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Address Line | 1140 MAIN ST
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City | LIVINGSTON
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State | CA
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Zip | 95334-1257
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Country | US
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Telephone | 209-394-7913
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Fax | 209-394-9093
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LESLIE MCGOWAN
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Credential |
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Telephone | 209-394-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | CA
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