Provider Demographics
NPI:1376033845
Name:LAKE NORMAN COMMUNITY HEALTH CLINIC
Entity Type:Organization
Organization Name:LAKE NORMAN COMMUNITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-316-6611
Mailing Address - Street 1:PO BOX 2398
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-2398
Mailing Address - Country:US
Mailing Address - Phone:704-316-6611
Mailing Address - Fax:704-316-6612
Practice Address - Street 1:14230 HUNTERS RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7335
Practice Address - Country:US
Practice Address - Phone:704-316-6611
Practice Address - Fax:704-316-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center