Basic Information
| Provider Information | |||||||||
| NPI: | 1114978582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINCOLN COMMUNITY HEALTH CENTER INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52119 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277172119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199564000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 FAYETTEVILLE ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277072325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199564000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOYE | ||||||||
| AuthorizedOfficialFirstName: | CLARETTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9199564022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 03055 | 01 | NC | GROUP BC/BS ID NUMBER | OTHER | 344500A | 05 | NC | MEDICAID | 344500C | 05 | NC | MEDICAID | 344500D | 05 | NC | MEDICAID |