Healthcare Provider Details

I. General information

NPI: 1639634819
Provider Name (Legal Business Name): KINSTON COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N QUEEN ST
KINSTON NC
28501-4932
US

IV. Provider business mailing address

324 N QUEEN ST
KINSTON NC
28501-4932
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-9800
  • Fax: 252-523-9790
Mailing address:
  • Phone: 252-522-9800
  • Fax: 252-523-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SUZANNE FREEMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 252-522-9800