{
"Npi": {
"NPI": "1407881691",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 669",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AHOSKIE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27910-0669",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-209-0237",
"MailingAddressFaxNumber": "252-209-0197",
"FirstLinePracticeLocationAddress": "120 HEALTH CENTER DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AHOSKIE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27910-8161",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-332-3548",
"PracticeLocationAddressFaxNumber": "252-332-1665",
"EnumerationDate": "07/12/2006",
"LastUpdateDate": "06/10/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "04/21/2025",
"NPIReactivationDate": "05/09/2025",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUNTLEY",
"AuthorizedOfficialFirstName": "LASHUN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "INTERIM CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "336-829-3198",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}