MEDICARE: CABARRUS ROWAN COMMUNITY HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194358770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABARRUS ROWAN COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-792-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-792-2313
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DON HOLLOMAN
Credential	:	M.ED
Telephone Number	:	704-792-2203

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	10/07/2020

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