Provider Demographics
NPI:1346329943
Name:COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-488-2201
Mailing Address - Street 1:P.O. BOX 378
Mailing Address - Street 2:111 N. MAIN
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-0378
Mailing Address - Country:US
Mailing Address - Phone:217-488-2201
Mailing Address - Fax:217-488-3508
Practice Address - Street 1:111 N. MAIN
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:IL
Practice Address - Zip Code:62670-0378
Practice Address - Country:US
Practice Address - Phone:217-488-2201
Practice Address - Fax:217-488-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE KNOWN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid
IL=========-001Medicaid
IL148925Medicare Oscar/Certification