Organization
LIVINGSTON COMMUNITY HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLIE TAMIKO MCGOWAN MPH (CEO)
(209) 394-1365
Entity
Organization
Contact information
Practice address
600 B ST BLDG B, LIVINGSTON, CA 95334-9593
(209) 394-7913
(209) 394-3660
Mailing address
600 B ST BLDG B, LIVINGSTON, CA 95334-9593
(209) 394-7913
(209) 394-3660
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP03897F
BREAST CANCER EARLY DETEC
CA
05
—
FHC03897F
—
CA
01
—
HAP03897F
HEALTH ACCESS PROGRAM
CA
01
—
ZZZ71885Y
BLUE SHIELD
CA
Enumeration date
12/15/2006
Last updated
04/13/2021
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