=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376406371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 N CAMERON AVE
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27101-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-703-6737
-----------------------------------------------------
Fax | 336-245-4592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202D MCGILL AVE NW
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-792-2242
-----------------------------------------------------
Fax | 704-792-2250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MAYRA RODRIGUEZ-CACERES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-792-2315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------