Healthcare Provider Details

I. General information

NPI: 1215242516
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 IRVING AVE
BRIDGETON NJ
08302-2121
US

IV. Provider business mailing address

14 N PEARL ST
BRIDGETON NJ
08302-1902
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-4700
  • Fax: 856-451-8685
Mailing address:
  • Phone: 856-451-4700
  • Fax: 856-451-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24368
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES C EDWARDS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 856-451-4700