Provider Demographics
NPI:1730663949
Name:AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Entity Type:Organization
Organization Name:AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUITTA
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-4292
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1216
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:800 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7200
Practice Address - Country:US
Practice Address - Phone:662-624-2504
Practice Address - Fax:662-624-4354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01173078Medicaid
MSCH046150Other340B
MS09014578Medicaid
MS09010039Medicaid
MS06071341Medicaid