MEDICARE: NEIGHBORHOOD HEALTH CLINIC, 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	332900000X	Non-Pharmacy Dispensing Site
2	251V00000X	Voluntary or Charitable Agency	ME30891	FL

General Provider Information

NPI Number	:	1801286836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD HEALTH CLINIC, INC

Provider Business Mailing Address
First Line	:	121 GOODLETTE RD N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6230
Country	:	US
Telephone Number	:	239-261-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 GOODLETTE RD N
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-6230
Country	:	US
Telephone Number	:	239-261-6600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LESLIE LASCHEID
Credential	:
Telephone Number	:	239-529-2246

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	02/11/2015

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