Healthcare Provider Details

I. General information

NPI: 1184037434
Provider Name (Legal Business Name): COMMUNITY HEALTH AND IMMUNIZATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 VILLA RD STE 301
GREENVILLE SC
29615-3038
US

IV. Provider business mailing address

668 N 44TH ST STE 100W
PHOENIX AZ
85008-6507
US

V. Phone/Fax

Practice location:
  • Phone: 864-451-7943
  • Fax:
Mailing address:
  • Phone: 877-358-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMMD.7722
License Number StateSC

VIII. Authorized Official

Name: REBEKAH SUAZO
Title or Position: DIRECTOR OF COMMUNITY DEVELOPMENT
Credential:
Phone: 480-646-9099