Provider Demographics
NPI:1861055535
Name:COMMUNITY HEALTH CARE CENTER INCORPORATED
Entity type:Organization
Organization Name:COMMUNITY HEALTH CARE CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-791-7903
Mailing Address - Street 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:406-454-6973
Mailing Address - Fax:
Practice Address - Street 1:105 6TH ST N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2531
Practice Address - Country:US
Practice Address - Phone:406-791-7903
Practice Address - Fax:406-791-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTFC0158495OtherDEA LICENSE