MEDICARE: COMMUNITY HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700816816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	14 N PEARL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 NORTH PEARL STREET
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-451-0029

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JAMES C EDWARDS
Credential	:
Telephone Number	:	856-451-4700

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/23/2022

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