Healthcare Provider Details

I. General information

NPI: 1336735638
Provider Name (Legal Business Name): VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5118 RICHMOND HENRICO TPKE
RICHMOND VA
23227-3627
US

IV. Provider business mailing address

2809 NORTH AVE
RICHMOND VA
23222-3647
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-0840
  • Fax:
Mailing address:
  • Phone: 804-780-0840
  • Fax: 804-329-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRACY CAUSEY
Title or Position: CEO
Credential:
Phone: 804-253-1968