Provider Demographics
NPI:1417131319
Name:HEALTHREACH COMMUNITY CLINIC
Entity Type:Organization
Organization Name:HEALTHREACH COMMUNITY CLINIC
Other - Org Name:MOORESVILLE SOUTH IREDELL HEALTH ASSISTANCE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RORY
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-663-1992
Mailing Address - Street 1:PO BOX 1265
Mailing Address - Street 2:400 E STATESVILLE AVE SUITE 300
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-1265
Mailing Address - Country:US
Mailing Address - Phone:704-663-1992
Mailing Address - Fax:704-663-2073
Practice Address - Street 1:400 E STATESVILLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2581
Practice Address - Country:US
Practice Address - Phone:704-663-1992
Practice Address - Fax:704-663-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable