Provider Demographics
NPI:1275053506
Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Entity Type:Organization
Organization Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Other - Org Name:CASSE COMMUNITY HEALTH INSTITUTE - BOSSIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-3350
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:318-688-3655
Practice Address - Street 1:2120 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3106
Practice Address - Country:US
Practice Address - Phone:318-688-3350
Practice Address - Fax:318-688-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2366866Medicaid