Healthcare Provider Details

I. General information

NPI: 1558652784
Provider Name (Legal Business Name): WARREN-VANCE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHARLES ROLLINS RD. SUITE 205
HENDERSON NC
27536-2882
US

IV. Provider business mailing address

120 CHARLES ROLLINS RD. SUITE 205
HENDERSON NC
27536-2882
US

V. Phone/Fax

Practice location:
  • Phone: 252-572-2610
  • Fax: 252-572-2621
Mailing address:
  • Phone: 252-572-2610
  • Fax: 252-572-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number1077723
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MICHELLE DENISE COLLINS-OGLE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 252-572-2610