Healthcare Provider Details

I. General information

NPI: 1629832621
Provider Name (Legal Business Name): CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MEDICAL PLAZA DR STE 300
CHARLOTTE NC
28262-8702
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 TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEFANI PRISCILIA RUARTE
Title or Position: LEAD REVENUE CYCLE SPECIALIST
Credential: CH-CBS
Phone: 704-316-6573