Organization
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF MOODY (C.O.O.)
(318) 688-3350
Entity
Organization
Contact information
Practice address
149 STONECREEK DR., STONEWALL, LA 71078-6100
(318) 688-3350
Mailing address
2120 BERT KOUNS INDUSTRIAL LOOP STE A, SHREVEPORT, LA 71118-3351
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2366866
—
LA
Enumeration date
06/27/2017
Last updated
07/24/2020
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