Provider Demographics
NPI:1407327620
Name:WHITE CLOUD HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:WHITE CLOUD HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-850-1801
Mailing Address - Street 1:3349B THRASHER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:KS
Mailing Address - Zip Code:66094-4005
Mailing Address - Country:US
Mailing Address - Phone:785-595-3450
Mailing Address - Fax:785-595-3493
Practice Address - Street 1:3349B THRASHER RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:KS
Practice Address - Zip Code:66094-4005
Practice Address - Country:US
Practice Address - Phone:785-595-3450
Practice Address - Fax:785-595-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center