Provider Demographics
NPI: | 1679822993 |
---|---|
Name: | RURAL HEALTH CARE, INCORPORATED |
Entity Type: | Organization |
Organization Name: | RURAL HEALTH CARE, INCORPORATED |
Other - Org Name: | AZA HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | SPENCER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 386-328-0108 |
Mailing Address - Street 1: | 1302 RIVER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PALATKA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32177-5042 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 386-326-7342 |
Mailing Address - Fax: | 386-325-1086 |
Practice Address - Street 1: | 201 WEST LATTIN STREET |
Practice Address - Street 2: | |
Practice Address - City: | HASTINGS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32145-4111 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-692-1508 |
Practice Address - Fax: | 904-692-1509 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-08-31 |
Last Update Date: | 2020-02-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |