Healthcare Provider Details

I. General information

NPI: 1487404679
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY STE 350
FORT WAYNE IN
46802-1412
US

IV. Provider business mailing address

PO BOX 11949
FORT WAYNE IN
46862-1949
US

V. Phone/Fax

Practice location:
  • Phone: 260-423-6621
  • Fax: 260-423-2675
Mailing address:
  • Phone: 260-458-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CICELY MCCOWAN
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 260-458-2641