Provider Demographics
NPI:1609266816
Name:FREE CLINIC OF ROCKINGHAM COUNTY, INC
Entity Type:Organization
Organization Name:FREE CLINIC OF ROCKINGHAM COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-349-3220
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-2668
Mailing Address - Country:US
Mailing Address - Phone:336-349-3220
Mailing Address - Fax:336-349-2725
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3815
Practice Address - Country:US
Practice Address - Phone:336-349-3220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable