Provider Demographics
NPI:1306495312
Name:MY COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:MY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:REGULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-363-3179
Mailing Address - Street 1:2600 7TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1709
Mailing Address - Country:US
Mailing Address - Phone:330-363-2218
Mailing Address - Fax:
Practice Address - Street 1:10029 CLEVELAND AVE. SE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:OH
Practice Address - Zip Code:44643
Practice Address - Country:US
Practice Address - Phone:234-386-0306
Practice Address - Fax:234-386-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty