1093795981 NPI number — COMMUNITY HEALTH CARE, INC.

Table of content: (NPI 1093795981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093795981 NPI number — COMMUNITY HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHC-IL HOMELESS DROP IN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093795981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52801-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-336-3000
Provider Business Mailing Address Fax Number:
563-336-3044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2209 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-8806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-336-3000
Provider Business Practice Location Address Fax Number:
563-336-3044
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOWMAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
563-336-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8122859 . This is a "ILLINOIS BC/BS GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 91681 . This is a "IA BCBS GRP# IN MOLINE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 92912 . This is a "IA BC/BS GRP# SEEN IN RI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0568980 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113373 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CP8565 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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