Provider Demographics
NPI:1013204312
Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:NOELA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-255-9170
Mailing Address - Street 1:4626 ALCEE FORTIER BOULEVARD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2130
Mailing Address - Country:US
Mailing Address - Phone:504-255-9170
Mailing Address - Fax:504-255-9190
Practice Address - Street 1:46S6 ALCEE FORTIER BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2130
Practice Address - Country:US
Practice Address - Phone:504-255-8665
Practice Address - Fax:504-234-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)