Provider Demographics
NPI:1902251275
Name:CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-316-6561
Mailing Address - Street 1:8401 MEDICAL PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8702
Mailing Address - Country:US
Mailing Address - Phone:704-316-6561
Mailing Address - Fax:704-384-1977
Practice Address - Street 1:5301 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5455
Practice Address - Country:US
Practice Address - Phone:704-316-6561
Practice Address - Fax:704-384-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)