Provider Demographics
NPI:1134532062
Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Entity type:Organization
Organization Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-3350
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:318-688-3655
Practice Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3351
Practice Address - Country:US
Practice Address - Phone:318-688-3350
Practice Address - Fax:318-688-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty