Healthcare Provider Details

I. General information

NPI: 1013135235
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 GRAVELLY LAKE DR SW
LAKEWOOD WA
98499-5036
US

IV. Provider business mailing address

1148 BROADWAY STE 100
TACOMA WA
98402-3518
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-7030
  • Fax: 253-597-4556
Mailing address:
  • Phone: 253-597-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID FLENTGE
Title or Position: CEO
Credential:
Phone: 253-597-4550