MEDICARE: LIVINGSTON COMMUNITY HEALTH

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)

General Provider Information

NPI Number	:	1295184117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGSTON COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	1140 MAIN ST
Second Line	:
City	:	LIVINGSTON
State	:	CA
Zip	:	95334-1257
Country	:	US
Telephone Number	:	209-394-7913
Fax Number	:	209-394-9093

Provider Business Practice Location Address
First Line	:	1010 W LAS PALMAS AVE STE E
Second Line	:
City	:	PATTERSON
State	:	CA
Zip	:	95363-8873
Country	:	US
Telephone Number	:	209-394-7913
Fax Number	:	209-394-9093

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LESLIE TAMIKO MCGOWAN
Credential	:	MPH
Telephone Number	:	209-394-7913

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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Directions to “LIVINGSTON COMMUNITY HEALTH ” Practice Location

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