Provider Demographics
NPI:1245392539
Name:COMMUNITY HEALTH INTERVENTION AND EDUCATION FOUNDATION INCORPORATED
Entity Type:Organization
Organization Name:COMMUNITY HEALTH INTERVENTION AND EDUCATION FOUNDATION INCORPORATED
Other - Org Name:FAMILY HEALTH & HELP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAYMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-569-5537
Mailing Address - Street 1:109 S JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1717
Mailing Address - Country:US
Mailing Address - Phone:765-569-4008
Mailing Address - Fax:765-569-1917
Practice Address - Street 1:109 S JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1717
Practice Address - Country:US
Practice Address - Phone:765-569-4008
Practice Address - Fax:765-569-1917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH INTERVENTION/EDUCATION FOUNDATION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20063300Medicaid
IN20063300AMedicaid
IN20063300Medicaid
IN=========OtherTAX ID
IN20063300AMedicaid