Provider Demographics
NPI:1619217742
Name:COMMONWEALTH HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:COMMONWEALTH HEALTHCARE CORPORATION
Other - Org Name:KAGMAN COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-256-5242
Mailing Address - Street 1:PO BOX 500409
Mailing Address - Street 2:LEMMAI WAY KAGMAN II
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0409
Mailing Address - Country:US
Mailing Address - Phone:670-256-5242
Mailing Address - Fax:670-256-5244
Practice Address - Street 1:1 LEMMAI WAY KAGMAN II
Practice Address - Street 2:BUILDINGS 1 & 2
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-0409
Practice Address - Country:US
Practice Address - Phone:670-256-5242
Practice Address - Fax:670-256-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP661800Medicare Oscar/Certification