Provider Demographics
NPI:1609312891
Name:AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Entity type:Organization
Organization Name:AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AURELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-624-4292
Mailing Address - Street 1:510 HIGHWAY 322
Mailing Address - Street 2:P O BOX 1216
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4717
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:1555 LEE DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-2914
Practice Address - Country:US
Practice Address - Phone:662-624-4292
Practice Address - Fax:662-624-4354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AARON E HENRY COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)