Provider Demographics
NPI:1457503385
Name:PROJECT VIDA HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PROJECT VIDA HEALTH CENTER, INC.
Other - Org Name:DIANA STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-7057
Mailing Address - Street 1:3607 RIVERA AVE.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2415
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-533-7158
Practice Address - Street 1:9555 DIANA DR.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6951
Practice Address - Country:US
Practice Address - Phone:915-533-7057
Practice Address - Fax:915-533-7158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROJECT VIDA HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671818Medicare Oscar/Certification