Provider Demographics
NPI:1366637969
Name:HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Other - Org Name:HENDERSON HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-659-3125
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-0720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1132 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1310
Practice Address - Country:US
Practice Address - Phone:731-983-3175
Practice Address - Fax:731-983-3356
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARDEMAN COUNTY COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0441916Medicaid
TN0441916Medicaid