Provider Demographics
NPI:1104340686
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:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-3350
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP STE A
Mailing Address - Street 2:
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 1:149 STONECREEK DR.
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-4906
Practice Address - Country:US
Practice Address - Phone:318-688-3350
Practice Address - Fax:318-688-3655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)