Provider Demographics
NPI:1407388754
Name:COMMUNITY CLINIC INC
Entity Type:Organization
Organization Name:COMMUNITY CLINIC INC
Other - Org Name:CCI HEALTH & WELLNESS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNOLHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:240-499-2609
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:2 TAFT CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1307
Practice Address - Country:US
Practice Address - Phone:240-753-7895
Practice Address - Fax:301-424-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)