1558652784 NPI number — WARREN-VANCE COMMUNITY HEALTH CENTER, INC.

Table of content: (NPI 1558652784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558652784 NPI number — WARREN-VANCE COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN-VANCE COMMUNITY HEALTH CENTER, 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:
6
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:
1558652784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 CHARLES ROLLINS RD.
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27536-2882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-572-2610
Provider Business Mailing Address Fax Number:
252-572-2621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 CHARLES ROLLINS RD.
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27536-2882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-572-2610
Provider Business Practice Location Address Fax Number:
252-572-2621
Provider Enumeration Date:
04/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS-OGLE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
252-572-2610

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: 1077723 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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