Provider Demographics
NPI:1235600990
Name:TENSAS COMMUNITY HEALTH CENTER INC.
Entity Type:Organization
Organization Name:TENSAS COMMUNITY HEALTH CENTER INC.
Other - Org Name:VIDALIA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-766-1967
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-0046
Mailing Address - Country:US
Mailing Address - Phone:318-766-1967
Mailing Address - Fax:318-766-9090
Practice Address - Street 1:900 CARTER ST STE A
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3208
Practice Address - Country:US
Practice Address - Phone:318-766-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENSAS COMMUNITY HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-06
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)