1356927594 NPI number — COMMUNITY OF HOPE HEALTH CLINIC- A VOLUNTEERS IN MEDICINE CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356927594 NPI number — COMMUNITY OF HOPE HEALTH CLINIC- A VOLUNTEERS IN MEDICINE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY OF HOPE HEALTH CLINIC- A VOLUNTEERS IN MEDICINE CLINIC
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:
1356927594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35124-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-644-8641
Provider Business Mailing Address Fax Number:
205-574-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2692 PELHAM PKWY STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35124-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-644-8640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2021

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
ROYCE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-644-8641

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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