Provider Demographics
NPI:1548891344
Name:HEALTHY COMMUNITIES OF CLINTON COUNTY INC
Entity type:Organization
Organization Name:HEALTHY COMMUNITIES OF CLINTON COUNTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-659-6063
Mailing Address - Street 1:1234 ROSSVILLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-1059
Mailing Address - Country:US
Mailing Address - Phone:765-659-6063
Mailing Address - Fax:
Practice Address - Street 1:1234 ROSSVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-1059
Practice Address - Country:US
Practice Address - Phone:765-659-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility