Provider Demographics
NPI: | 1518222306 |
---|---|
Name: | COMMUNITY HEALTH CENTERS AT RED ROCK |
Entity Type: | Organization |
Organization Name: | COMMUNITY HEALTH CENTERS AT RED ROCK |
Other - Org Name: | CHCI AT REDROCK |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ISABELLA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LAWSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MBA |
Authorized Official - Phone: | 405-769-3301 |
Mailing Address - Street 1: | PO BOX 30589 |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73140 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-769-3301 |
Mailing Address - Fax: | 405-769-9685 |
Practice Address - Street 1: | 4400 N. LINCOLN BLVD |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73105 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-769-3301 |
Practice Address - Fax: | 405-769-9685 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-07-09 |
Last Update Date: | 2017-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |