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General NPI Number Information
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NPI Number | 1972739191
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Entity Type | Organization
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Legal Business Name | COMMON GROUND HEALTH CLINIC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 1400 TECHE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70114-5843
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Country | US
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Telephone | 504-365-8800
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Fax | 504-368-9836
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Provider Business Mailing Address
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Address Line | 1400 TECHE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70114-5843
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Country | US
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Telephone | 504-365-8800
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Fax | 504-368-9836
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANTOR ODU NDEP
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Credential | MPH
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Telephone | 504-365-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | LA
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