Organization
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Active
Other names
David Raines School Based Health Center-Oak Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE C. WHITE III (CHIEF EXECUTIVE OFFICER)
(318) 227-3350
Entity
Organization
Contact information
Practice address
4331 HENRY ST, SHREVEPORT, LA 71109-6820
(318) 635-2141
Mailing address
3041 MARTIN LUTHER KING JR. DRIVE, SHREVEPORT, LA 71107-5899
(318) 227-3350
(318) 222-2979
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1941638
—
LA
Enumeration date
06/17/2019
Last updated
06/17/2019
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