Healthcare Provider Details

I. General information

NPI: 1407881691
Provider Name (Legal Business Name): ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date: 04/21/2025
Reactivation Date: 05/09/2025

III. Provider practice location address

120 HEALTH CENTER DR
AHOSKIE NC
27910-8161
US

IV. Provider business mailing address

PO BOX 669
AHOSKIE NC
27910-0669
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-3548
  • Fax: 252-332-1665
Mailing address:
  • Phone: 252-209-0237
  • Fax: 252-209-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LASHUN HUNTLEY
Title or Position: INTERIM CEO
Credential:
Phone: 336-829-3198