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General NPI Number Information
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NPI Number | 1265438998
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Entity Type | Organization
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Legal Business Name | DAVID RAINES COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 128 HOMER RD
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City | MINDEN
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State | LA
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Zip | 71055-2732
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Country | US
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Telephone | 318-377-1545
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Fax | 318-377-1504
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Provider Business Mailing Address
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Address Line | 3041 DR MARTIN LUTHER KING DR
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City | SHREVEPORT
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State | LA
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Zip | 71107-4705
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Country | US
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Telephone | 318-227-3350
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Fax | 318-222-2979
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIE C WHITE
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Credential |
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Telephone | 318-425-2252
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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 | LA
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