Provider Demographics
NPI:1710386164
Name:COMMUNITY HEALTH AND DENTAL CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AND DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGIVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-326-9460
Mailing Address - Street 1:351 W SCHUYLKILL RD STE G-15A
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7438
Mailing Address - Country:US
Mailing Address - Phone:610-326-9460
Mailing Address - Fax:610-222-5006
Practice Address - Street 1:700 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3297
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH AND DENTAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-21
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3293340261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391040Medicare Oscar/Certification