1477819886 NPI number — COMMUNITY HEALTH CARE, INC

Table of content: (NPI 1477819886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477819886 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:
Provider Other Organization Name Type Code:
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:
1477819886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
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:
563-336-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 15TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61244-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-327-2015
Provider Business Practice Location Address Fax Number:
563-327-2045
Provider Enumeration Date:
04/10/2012

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" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1932193224 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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