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Organization
FRESH START COMMUNITY HEALTH CENTER LLC
Active
Organization
FRESH START COMMUNITY HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEESHA S DINKINS (BUSINESS MANAGER)
(318) 688-8190
Entity
Organization
Contact information
Practice address
351 W 79TH ST, SHREVEPORT, LA 71106
(318) 688-8190
Mailing address
351 W 79TH ST, SHREVEPORT, LA 71106-4819
(318) 779-0873
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QR0800X
Recovery Care Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/11/2018
Last updated
07/24/2019
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