Organization
WHITE GRAPE COMMUNITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUANISHA THOMAS (OWNER)
(310) 734-9895
Entity
Organization
Contact information
Practice address
92376 E RD, ASTORIA, OR 97103-6610
(310) 734-9895
Mailing address
92376 E RD, ASTORIA, OR 97103-6610
(310) 734-9895
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/29/2023
Last updated
10/31/2024
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