Basic Information
| Provider Information | |||||||||
| NPI: | 1366612277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 597 | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083020433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566913300 | ||||||||
| FaxNumber: | 8567947183 | ||||||||
| Practice Location | |||||||||
| Address1: | 8879 HIGHLAND ST | ||||||||
| Address2: | |||||||||
| City: | PORT NORRIS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083493420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566913300 | ||||||||
| FaxNumber: | 8567947183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 03/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | WALTER | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 8566913300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.