Healthcare Provider Details

I. General information

NPI: 1639878465
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: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N 25TH ST STE 101
RICHMOND VA
23223-6539
US

IV. Provider business mailing address

1620 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051-3219
US

V. Phone/Fax

Practice location:
  • Phone: 804-215-2938
  • Fax: 804-942-0203
Mailing address:
  • Phone: 817-913-7247
  • Fax: 817-720-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

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