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General NPI Number Information
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NPI Number | 1578858247
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Entity Type | Organization
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Legal Business Name | WARREN COMMUNITY HEALTH CLINIC INC.
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 546 W RIDGEWAY ST
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City | WARRENTON
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State | NC
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Zip | 27589-1716
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Country | US
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Telephone | 252-257-1904
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Fax | 252-257-1142
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Provider Business Mailing Address
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Address Line | 546 W RIDGEWAY ST
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City | WARRENTON
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State | NC
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Zip | 27589-1716
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Country | US
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Telephone | 252-257-1904
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Fax | 252-257-1142
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARY JONES SOMERVILLE
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Credential | ETC
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Telephone | 252-257-1904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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