Organization
DAVID RAINES COMMUNITY HEALTH CENTER, INC
Active
Other names
David Raines School Based Health Center-Keithville Elementary/Middle
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIE C WHITE III (CHIEF EXECUTIVE OFFICER)
(318) 227-3342
Entity
Organization
Contact information
Practice address
12201 MANSFIELD RD, KEITHVILLE, LA 71047-8534
(318) 364-5180
(318) 364-5186
Mailing address
3041 DR MARTIN LUTHER KING DR, SHREVEPORT, LA 71107-4705
(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
07/25/2022
Last updated
07/25/2022
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