1912980251 NPI number — COMMUNITY HEALTH CARE, INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912980251 NPI number — COMMUNITY HEALTH CARE, INC.

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 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:

1912980251

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/29/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1720 LAKEPOINTE DR STE 117

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LEWISVILLE

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75057-6425

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

214-379-3300

Provider Business Mailing Address Fax Number:

214-853-9018

Provider First Line Business Practice Location Address:

130 SOUTHAMPTON RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WESTFIELD

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01085-1370

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

413-568-6600

Provider Business Practice Location Address Fax Number:

413-562-8360

Provider Enumeration Date:

11/21/2005

Authorized Official Last Name:

JARVIE

Authorized Official First Name:

BRUCE

Authorized Official Middle Name:

Authorized Official Title or Position:

VP, TREASURER

Authorized Official Telephone Number:

214-379-3300

• Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 163WA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 110028022F , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022H , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022D , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1307185 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022G , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110028022E , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".