Provider Demographics
NPI:1326414368
Name:COMMUNITY HEALTH CONCEPTS - DODGE, LLC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CONCEPTS - DODGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-932-2738
Mailing Address - Street 1:187 N CHURCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5154
Mailing Address - Country:US
Mailing Address - Phone:800-932-2738
Mailing Address - Fax:
Practice Address - Street 1:2425 WESTGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2287
Practice Address - Country:US
Practice Address - Phone:800-932-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047-0419HOtherGA DEPT OF COMMUNITY HEALTH
GA003181972AMedicaid