Provider Demographics
NPI:1003257437
Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:ROANOKE CHOWAN COMMUNITY HEALTH CENTER INC
Other - Org Name:HERTFORD COUNTY STUDENT WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WROTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-0237
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0669
Mailing Address - Country:US
Mailing Address - Phone:252-209-0237
Mailing Address - Fax:
Practice Address - Street 1:1850 HWY 11 NORTH
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-1134
Practice Address - Country:US
Practice Address - Phone:252-367-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC029TUOtherBCBS OF NORTH CAROLINA
NC016X0OtherBCBS
NC344523AMedicaid
NC341891Medicare Oscar/Certification
NC2346117Medicare PIN