Provider Demographics
NPI:1629334016
Name:ROBESON HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:ROBESON HEALTH CARE CORPORATION
Other - Org Name:MONTGOMERY COUNTY COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-2900
Mailing Address - Street 1:60 COMMERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:103 COTTON CREEK RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356
Practice Address - Country:US
Practice Address - Phone:910-428-9020
Practice Address - Fax:910-428-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344054AMedicaid
NC026KUOtherBCBS
NC344054CMedicaid
NC344054AMedicaid
NC344054CMedicaid