Organization
NORTHEAST RURAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY L TENNANT SR. (ADMINISTRATOR)
(318) 387-4878
Entity
Organization
Contact information
Practice address
1108 STUBBS AVENUE, MONROE, LA 71207
(318) 387-4878
(318) 387-1317
Mailing address
PO BOX 2141, MONROE, LA 71207-0000
(318) 387-4878
(318) 387-1317
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1947695
—
LA
Enumeration date
08/25/2006
Last updated
08/22/2020
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