Provider Demographics
NPI:1558308080
Name:THE C.W. WILLIAMS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:THE C.W. WILLIAMS COMMUNITY HEALTH CENTER, INC
Other - Org Name:METROLINA COMPREHENSIVE HEALTH CENTER, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-391-0819
Mailing Address - Street 1:PO BOX 668093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8093
Mailing Address - Country:US
Mailing Address - Phone:704-393-7720
Mailing Address - Fax:704-398-3173
Practice Address - Street 1:3333 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5631
Practice Address - Country:US
Practice Address - Phone:704-391-0819
Practice Address - Fax:704-398-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344507AMedicaid
NC344507CMedicaid
NC344507CMedicaid
NC0739Medicare PIN