Basic Information
| Provider Information | |||||||||
| NPI: | 1669130209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKS COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 PENN ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196013527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847724091 | ||||||||
| FaxNumber: | 6103741629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 ROCKLAND ST | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196041501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109883848 | ||||||||
| FaxNumber: | 4847721112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2021 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | KARGBO | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | HELEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4847724091 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P2201X | N | 193400000X SINGLE SPECIALTY GROUP | 333600000X | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | AA0003086596 | 05 | PA | MEDICAID |