Healthcare Provider Details

I. General information

NPI: 1982950473
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BOW LN
MIDDLETOWN CT
06457-4710
US

IV. Provider business mailing address

575 MAIN ST FL 2 ATTN: CREDENTIALING DEPT
MIDDLETOWN CT
06457-2845
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax:
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0431
License Number StateCT

VIII. Authorized Official

Name: MARGARET FLINTER
Title or Position: SVP/CLINICAL DIRECTOR
Credential: APRN, PHD
Phone: 860-347-6971