Organization
LIVINGSTON COMMUNITY HEALTH
Active
Parent organization
LIVINGSTON COMMUNITY HEALTH
Other names
Bentley Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIVINGSTON COMMUNITY HEALTH
Authorized official
MRS. LESLIE MCGOWAN MPH (CHIEF EXECUTIVE OFFICER)
(209) 394-7913
Entity
Organization
Contact information
Practice address
12619 BENTLEY ST, WATERFORD, CA 95386-9011
(209) 442-6200
(209) 394-9093
Mailing address
1140 MAIN ST, LIVINGSTON, CA 95334-1257
(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
—
751901
MEDICARE OSCAR/CERTIFICATION
CA
Enumeration date
12/02/2015
Last updated
08/01/2017
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