Basic Information
| Provider Information | |||||||||
| NPI: | 1336742501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATES FOR A HEALTHY COMMUNITY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 E TAMPA ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658061131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178511551 | ||||||||
| FaxNumber: | 4178653479 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 HOOVER ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655362685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173348337 | ||||||||
| FaxNumber: | 4175322067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | JO | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4178511551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.