Provider Demographics
NPI:1235547787
Name:LOS BARRIOS UNIDOS COMMUNITY CLINIC, INC
Entity type:Organization
Organization Name:LOS BARRIOS UNIDOS COMMUNITY CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF HUMAN RESOURCES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-2285
Mailing Address - Street 1:809 SINGLETON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4014
Mailing Address - Country:US
Mailing Address - Phone:214-540-0300
Mailing Address - Fax:214-651-9514
Practice Address - Street 1:4732 W. ILLINOIS
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-540-0300
Practice Address - Fax:214-651-9514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS BARRIOS UNIDOS COMMUNITY CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)