Provider Demographics
NPI: | 1811385487 |
---|---|
Name: | COMMUNITY HEALTH AND IMMUNIZATION SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | COMMUNITY HEALTH AND IMMUNIZATION SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF COMMUNITY DEVELOPMENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 480-646-9031 |
Mailing Address - Street 1: | 320 WHITTINGTON PKWY STE 201B |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40222-4918 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 320 WHITTINGTON PKWY STE 201B |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40222-4918 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-646-9031 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-01-05 |
Last Update Date: | 2015-01-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 172V00000X | Other Service Providers | Community Health Worker | Group - Single Specialty |