Organization
DAVID RAINES COMMUNITY HEALTH CENTERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE C WHITE (CEO)
(318) 425-2252
Entity
Organization
Contact information
Practice address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 425-2252
(318) 227-8510
Mailing address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107
(318) 425-2252
(318) 227-8510
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5D174
MEDICARE PTAN NUMBER
LA
Enumeration date
02/25/2008
Last updated
02/25/2008
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