Provider Demographics
NPI:1619342706
Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM, CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-829-3198
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0669
Mailing Address - Country:US
Mailing Address - Phone:252-209-0237
Mailing Address - Fax:252-209-0197
Practice Address - Street 1:9500 NC HIGHWAY 94 N
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:NC
Practice Address - Zip Code:27928-8300
Practice Address - Country:US
Practice Address - Phone:252-797-0135
Practice Address - Fax:833-755-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02CEKOtherBCBS OF NORTH CAROLINA
NC1619342706Medicaid