Healthcare Provider Details

I. General information

NPI: 1992616221
Provider Name (Legal Business Name): CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N TRYON ST
CHARLOTTE NC
28206-2060
US

IV. Provider business mailing address

8401 MEDICAL PLAZA DR STE 300
CHARLOTTE NC
28262-8702
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-6561
  • Fax: 704-384-1977
Mailing address:
  • Phone: 704-316-6561
  • Fax: 704-384-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEFANI PRISCILIA RUARTE
Title or Position: REVENUE CYCLE SUPERVISOR
Credential:
Phone: 704-316-6573