Provider Demographics
NPI:1043392921
Name:WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-255-4870
Mailing Address - Street 1:257 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4120
Mailing Address - Country:US
Mailing Address - Phone:828-285-0622
Mailing Address - Fax:828-285-9421
Practice Address - Street 1:257 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4120
Practice Address - Country:US
Practice Address - Phone:828-285-0622
Practice Address - Fax:828-285-9421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344583CMedicaid
NC344583CMedicaid