Provider Demographics
NPI:1043618309
Name:SOUTHWEST COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHWEST COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLESETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-799-3528
Mailing Address - Street 1:5705 W 65TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-3827
Mailing Address - Country:US
Mailing Address - Phone:501-779-3528
Mailing Address - Fax:501-582-4208
Practice Address - Street 1:5705 W 65TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3827
Practice Address - Country:US
Practice Address - Phone:501-779-3528
Practice Address - Fax:501-562-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable