Provider Demographics
NPI:1902254618
Name:COMMUNITY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-335-3334
Mailing Address - Street 1:943 FOURTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6409
Mailing Address - Country:US
Mailing Address - Phone:724-335-3334
Mailing Address - Fax:724-335-2283
Practice Address - Street 1:179 COLUMBIA AVENUE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-2106
Practice Address - Country:US
Practice Address - Phone:724-335-3334
Practice Address - Fax:724-335-2283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035908L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012676430006Medicaid
PA1012676430006Medicaid