Healthcare Provider Details

I. General information

NPI: 1558526707
Provider Name (Legal Business Name): UPWARD BOUND COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9128 COLLIERS CHAPEL CHURCH RD
LINDEN NC
28356-9242
US

IV. Provider business mailing address

9128 COLLIERS CHAPEL CHURCH RD
LINDEN NC
28356-9242
US

V. Phone/Fax

Practice location:
  • Phone: 910-980-2131
  • Fax:
Mailing address:
  • Phone: 910-980-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA ELLIOTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-823-6103