Provider Demographics
NPI:1679875744
Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-255-8665
Mailing Address - Street 1:13085 CHEF MENTEUR HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-1804
Mailing Address - Country:US
Mailing Address - Phone:504-255-8665
Mailing Address - Fax:504-254-6447
Practice Address - Street 1:13085 CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-1804
Practice Address - Country:US
Practice Address - Phone:504-255-8665
Practice Address - Fax:504-254-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2111108Medicaid
LA2136640Medicaid
LA191885Medicare Oscar/Certification
LA5DM26Medicare PIN