Provider Demographics
NPI:1760191811
Name:LIVINGSTON COMMUNITY HEALTH
Entity Type:Organization
Organization Name:LIVINGSTON COMMUNITY HEALTH
Other - Org Name:MODESTO HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABASTA-CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-850-3500
Mailing Address - Street 1:600 B STREET
Mailing Address - Street 2:BLDG A
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9593
Mailing Address - Country:US
Mailing Address - Phone:209-850-3500
Mailing Address - Fax:209-850-3499
Practice Address - Street 1:2116 E. ORANGEBURG AVE.
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3370
Practice Address - Country:US
Practice Address - Phone:209-850-3500
Practice Address - Fax:209-850-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)