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General NPI Number Information
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NPI Number | 1417131319
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Entity Type | Organization
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Legal Business Name | HEALTHREACH COMMUNITY CLINIC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 400 E STATESVILLE AVE SUITE 300
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City | MOORESVILLE
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State | NC
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Zip | 28115-2581
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Country | US
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Telephone | 704-663-1992
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Fax | 704-663-2073
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Provider Business Mailing Address
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Address Line | PO BOX 1265 400 E STATESVILLE AVE SUITE 300
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City | MOORESVILLE
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State | NC
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Zip | 28115-1265
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Country | US
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Telephone | 704-663-1992
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Fax | 704-663-2073
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHARLES RORY CRAWFORD
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Credential |
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Telephone | 704-663-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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