Provider Demographics
NPI:1407025125
Name:TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Entity Type:Organization
Organization Name:TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Other - Org Name:COMMWELL HEALTH - DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-567-6194
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NEWTON GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28366-0227
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:910-567-4389
Practice Address - Street 1:3331 EASY ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7988
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:910-567-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344560EMedicaid