Provider Demographics
NPI:1134687478
Name:COMMUNITY CENTER LLC
Entity type:Organization
Organization Name:COMMUNITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:HESTER
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:318-914-2955
Mailing Address - Street 1:144 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-2206
Mailing Address - Country:US
Mailing Address - Phone:318-914-2955
Mailing Address - Fax:
Practice Address - Street 1:144 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-2206
Practice Address - Country:US
Practice Address - Phone:318-914-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty