Provider Demographics
NPI:1093795981
Name:COMMUNITY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE, INC.
Other - Org Name:CHC-IL HOMELESS DROP IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-336-3000
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3044
Practice Address - Street 1:2209 3RD AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8806
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8122859OtherILLINOIS BC/BS GROUP #
IA91681OtherIA BCBS GRP# IN MOLINE
IA92912OtherIA BC/BS GRP# SEEN IN RI
IA0568980Medicaid
IL113373OtherUNITED HEALTHCARE
IACP8565OtherRAILROAD MEDICARE GROUP #
IL113373OtherUNITED HEALTHCARE
IA91681OtherIA BCBS GRP# IN MOLINE
IL207707Medicare PIN
IL=========010Medicaid