Healthcare Provider Details

I. General information

NPI: 1699089847
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 LANDIS AVENUE
VINELAND NJ
08360-3423
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: 856-794-7183
Mailing address:
  • Phone: 856-451-4700
  • Fax: 856-794-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number24405
License Number StateNJ

VIII. Authorized Official

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