Basic Information
| Provider Information | |||||||||
| NPI: | 1649525569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKS COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 PENN ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196021108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109884838 | ||||||||
| FaxNumber: | 6102884515 | ||||||||
| Practice Location | |||||||||
| Address1: | 838 PENN ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196021108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109884838 | ||||||||
| FaxNumber: | 6109884824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | KARGBO | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6109884838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
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 | 102691224-0002 | 05 | PA | MEDICAID |