Provider Demographics
NPI:1497562300
Name:DISTRICT CLINIC HOLDINGS INC
Entity type:Organization
Organization Name:DISTRICT CLINIC HOLDINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-804-5885
Mailing Address - Street 1:1515 N FLAGLER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3429
Mailing Address - Country:US
Mailing Address - Phone:561-659-1270
Mailing Address - Fax:561-804-5629
Practice Address - Street 1:4801 S CONGRESS AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-642-1000
Practice Address - Fax:561-439-4384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISTRICT CLINIC HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)