MEDICARE: DAVID RAINES COMMUNITY HEALTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265438998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID RAINES COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	3041 DR MARTIN LUTHER KING DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-4705
Country	:	US
Telephone Number	:	318-227-3350
Fax Number	:	318-222-2979

Provider Business Practice Location Address
First Line	:	128 HOMER RD
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-2732
Country	:	US
Telephone Number	:	318-377-1545
Fax Number	:	318-377-1504

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILLIE C WHITE
Credential	:
Telephone Number	:	318-425-2252

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	02/13/2024

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