Provider Demographics
NPI:1568914521
Name:MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Entity Type:Organization
Organization Name:MOUNTAIN COMMUNITY HEALTH PARTNERSHIP INCORPORATED
Other - Org Name:CELO HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-675-4116
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-0027
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:
Practice Address - Street 1:116 SEVEN MILE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8509
Practice Address - Country:US
Practice Address - Phone:828-675-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568914521Medicaid