Organization
DAVID RAINES COMMUNITY HEALTH CENTER, INC
Active
Other names
David Raines School Based Health Center- Bossier High School
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE C. WHITE III (CHIEF EXECUTIVE OFFICER)
(318) 723-7242
Entity
Organization
Contact information
Practice address
777 BEARKAT DR, BOSSIER CITY, LA 71111-4565
(318) 723-7242
Mailing address
3041 DR MARTIN LUTHER KING DR, SHREVEPORT, LA 71107-4705
(318) 723-7242
(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
06/25/2024
Last updated
06/25/2024
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