Organization
ADVOCATES FOR A HEALTHY COMMUNITY, INC
Active
Other names
JORDAN VALLEY COMMUNITY HEALTH CENTER-PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH BROOKS MILLER JR. (EXECUTIVE DIRECTOR)
(417) 831-0150
Entity
Organization
Contact information
Practice address
860 LYNN ST, LEBANON, MO 65536-3832
(417) 831-0150
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 851-1551
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
09/11/2006
Last updated
12/02/2021
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