Healthcare Provider Details

I. General information

NPI: 1295613891
Provider Name (Legal Business Name): COMMUNITY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 1106
SILVER SPRING MD
20910-3836
US

IV. Provider business mailing address

8665 GEORGIA AVE
SILVER SPRING MD
20910-3405
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LATECHIA SAHRELL CHAMBERS
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 240-839-4363