Provider Demographics
NPI:1073367249
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 OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLMES
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 1:3400 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3212
Practice Address - Country:US
Practice Address - Phone:704-316-6561
Practice Address - Fax:704-384-1977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-15
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)